Treatment of cryptosporidiosis in immunocompromised individuals: systematic review and meta‐analysis
Open Access
- 1 March 2007
- journal article
- research article
- Published by Wiley in British Journal of Clinical Pharmacology
- Vol. 63 (4), 387-393
- https://doi.org/10.1111/j.1365-2125.2007.02873.x
Abstract
Cryptosporidium is a common cause of gastroenteritis and is associated with severe life‐threatening illness among immunocompromised individuals. This review aimed to assess the efficacy of interventions for the treatment and prevention of cryptosporidiosis among immunocompromised patients. A search of Medline, Embase and other electronic databases was carried out up to August 2005. Two reviewers independently extracted data and assessed study quality. The relative risk for each intervention was calculated. Seven trials involving 169 participants were included. Nitazoxanide and paramomycin were associated with a relative risk (RR) of reduction in the duration and frequency of diarrhoea of 0.83 [95% confidence interval (CI) 0.36, 1.94] and 0.74 (95% CI 0.42, 1.31), respectively, showing no evidence of effectiveness. Nitazoxanide led to significant evidence of oocyst clearance compared with placebo with a RR of 0.52 (95% CI 0.30, 0.91). The effect was not significant for HIV‐seropositive participants (RR 0.71, 95% CI 0.36, 1.37). HIV‐seronegative participants on nitazoxanide had a significantly higher relative risk of achieving parasitological clearance of 0.26 (95% CI 0.09, 0.80) based on a single study. No other intervention was associated with either a reduction in diarrhoea, mortality or a significant parasitological response. This review confirms the absence of evidence for effective agents in the management of cryptosporidiosis. The results indicate that nitaxozanide reduces load of parasites and may be useful in immunocompetent individuals. The absence of effective therapy highlights the importance of preventive interventions in this group of patients.Keywords
This publication has 45 references indexed in Scilit:
- Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysisThe Lancet Infectious Diseases, 2005
- A randomized, blinded, controlled trial investigating the gastrointestinal health effects of drinking water quality.Environmental Health Perspectives, 2001
- Eradication of Cryptosporidia and Microsporidia Following Successful Antiretroviral TherapyJAIDS Journal of Acquired Immune Deficiency Syndromes, 2000
- A double-‘blind’ placebo-controlled study of nitazoxanide in the treatment of cryptosporidial diarrhoea in aids patients in MexicoTransactions of the Royal Society of Tropical Medicine and Hygiene, 1998
- Treatment of HIV-1-associated microsporidiosis and cryptosporidiosis with combination antiretroviral therapyThe Lancet, 1998
- Assessing the quality of reports of randomized clinical trials: Is blinding necessary?Controlled Clinical Trials, 1996
- Paromomycin for Cryptosporidiosis in AIDS: A Prospective, Double-Blind TrialThe Journal of Infectious Diseases, 1994
- A Controlled Trial of Bovine Dialyzable Leukocyte Extract for Cryptosporidiosis in Patients with AIDSThe Journal of Infectious Diseases, 1990
- Spiramycin Is Not Effective in Treating Cryptosporidium Diarrhea in Infants: Results of A Double-Blind Randomized TrialThe Journal of Infectious Diseases, 1989
- Treatment of Cryptosporidiosis with Spiramycin in AIDSJournal of Clinical Gastroenterology, 1987