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


METHODS
Randomized, controlled trial.


METHODS
HIV clinic in Port-au-Prince, Haiti.


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


METHODS
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).


METHODS
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.
Verdier
R I
RI
Cornell University Medical College, New York, New York 10021, USA.
Fitzgerald
D W
DW
Johnson
W D
WD
Pape
J W
JW
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000293:Adolescent; D000328:Adult; D000818:Animals; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D002939:Ciprofloxacin / Q000627:therapeutic use*; D003048:Coccidiosis / Q000188:drug therapy*; D003967:Diarrhea / Q000188:drug therapy / Q000382:microbiology; D004334:Drug Administration Schedule; D016783:Eucoccidiida; D006801:Humans; D007549:Isospora; D008875:Middle Aged; D012008:Recurrence; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination