Trimethoprim-sulfamethoxazole compared with ciprofloxacin for treatment and prophylaxis of Isospora belli and Cyclospora cayetanensis infection in HIV-infected patients. A randomized, controlled trial.

Abstract

BACKGROUND:

In developing countries, Isospora belli and Cyclospora cayetanensis frequently cause chronic diarrhea in HIV-infected patients.

OBJECTIVE:

To compare 1 week of trimethoprim-sulfamethoxazole treatment and 1 week of ciprofloxacin treatment in HIV-infected patients with chronic diarrhea caused by I. belli and C. cayetanensis.

DESIGN:

Randomized, controlled trial.

SETTING:

HIV clinic in Port-au-Prince, Haiti.

PATIENTS:

42 HIV-infected patients with chronic diarrhea due to I. belli (n = 22) or C cayetanensis (n = 20).

INTERVENTIONS:

Patients were randomly assigned to receive oral trimethoprim-sulfamethoxazole (160 mg or 800 mg) or ciprofloxacin (500 mg) twice daily for 7 days. Patients who responded clinically and microbiologically received prophylaxis for 10 weeks (1 tablet orally, three times per week).

MEASUREMENTS:

Treatment success was measured by cessation of diarrhea and negative stool examination at day 7. Prophylaxis success was measured by recurrent disease rate.

RESULTS:

Diarrhea ceased in all 19 patients treated with trimethoprim-sulfamethoxazole. Eighteen of 19 patients had negative results on stool examination at day 7 (95%). Among the 23 patients who received ciprofloxacin, diarrhea ceased in 20 (87% [CI; 66% to 97%]) and 16 had negative results on stool examination at day 7 (70%). By survival analysis, diarrhea from isosporiasis and cyclosporiasis ceased more rapidly with trimethoprim-sulfamethoxazole than with ciprofloxacin. All patients receiving secondary prophylaxis with trimethoprim-sulfamethoxazole remained disease-free, and 15 of 16 patients receiving secondary prophylaxis with ciprofloxacin remained disease-free.

CONCLUSIONS:

A 1-week course of trimethoprim-sulfamethoxazole is effective in HIV-infected patients with cyclosporiasis or isosporiasis. Although ciprofloxacin is not as effective, it is acceptable for patients who cannot tolerate trimethoprim-sulfamethoxazole.

• Authors: R I Verdier, D W Fitzgerald, W D Johnson Jr, J W Pape
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 132 Issue 11 Pg. 885-8 (Jun 06 2000) ISSN: 0003-4819 [Print] United States
• PMID: 10836915 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Anti-Infective Agents
• Ciprofloxacin
• Trimethoprim, Sulfamethoxazole Drug Combination

Topics

• AIDS-Related Opportunistic Infections (drug therapy)
• Adolescent
• Adult
• Animals
• Anti-Infective Agents (therapeutic use)
• Chronic Disease
• Ciprofloxacin (therapeutic use)
• Coccidiosis (drug therapy)
• Diarrhea (drug therapy, microbiology)
• Drug Administration Schedule
• Eucoccidiida
• Humans
• Isospora
• Middle Aged
• Recurrence
• Trimethoprim, Sulfamethoxazole Drug Combination (therapeutic use)