Sandbox carlos: Difference between revisions

Revision as of 18:13, 16 July 2015

In the immunocompetent hosts, symptoms of Cystoisospora infection are usually self-limited.
Antimicrobial therapy to immunocompetent patients may be considered if symptoms do not start to resolve spontaneously after 5 to 7 days (depending upon severity)

Prefered regimen: Trimethoprim-sulfamethoxazole 160 mg/800 mg PO bid for 7-10 days
Alternative regimen (1) (for patients who are allergic to or intolerant of TMP-SMX): Pyrimethamine 50-75 mg/day PO qd or divided in 2 equal doses AND Leucovorin 10–25 mg PO qd
Alternative regimen (2): Ciprofloxacin 500 mg PO bid for 7 days (second-line alternative)

Insufficient evidence is available to support a general recommendation for primary prophylaxis for Cystoisosporiasis per se, especially for U.S. travelers in isoporiasis-endemic areas.

2.2 Secondary prophylaxis (preventing recurrence in patients with CD4 count < 200 cells/mm³)

Prefered regimen: Trimethoprim-sulfamethoxazole 160 mg/800 mg PO 3 times weekly
Alternative regimen (1): Trimethoprim-sulfamethoxazole 160 mg/800 mg PO qd
Alternative regimen (2): Trimethoprim-sulfamethoxazole 320 mg/1600 mg PO 3 times weekly
Alternative regimen (3): Pyrimethamine 25 mg PO qd AND Leucovorin 5–10 mg PO qd
Alternative regimen (4): Ciprofloxacin 500 mg PO 3 times weekly (second-line alternative)
Note (1): Criteria for discontinuation of chronic maintenance therapy: sustained increase in CD4 count > 200 cells/mm³ for > 6 months in response to ART and without evidence of active Cystoisospora belli infection
Note (2): Because of concerns about possible teratogenicity associated with first-trimester drug exposure, clinicians may withhold secondary prophylaxis during the first trimester and treat only symptomatic infection.

Prefered regimen: Trimethoprim-sulfamethoxazole 160 mg/800 mg PO OR IV qid for 10 days

Alternative regimen (1): Pyrimethamine 50-75 mg PO daily AND Leucovorin 10–25 mg PO daily
Alternative regimen (2): Ciprofloxacin 500 mg PO BID for 7 days

Prefered regimen: Trimethoprim-sulfamethoxazole 160 mg/800 mg PO 3 times weekly
Alternative regimen (1): Trimethoprim-sulfamethoxazole 320 mg/1600 mg PO 3 times weekly
Alternative regimen (2): Pyrimethamine 25 mg PO daily AND Leucovorin 5–10 mg PO daily
Alternative regimen (3): Ciprofloxacin 500 mg PO 3 times weekly

@@ Line 2: / Line 2: @@
 {{PBI|Cystoisospora belli}}
-:* 1. '''Cystoisospora belli treatment'''
+:* 1. '''Cystoisospora belli treatment'''<ref>{{cite web | title = CDC - Cystoisosporiasis | url = http://www.cdc.gov/parasites/cystoisospora/health_professionals/index.html }}</ref>
 ::* 1.1 '''Immunocompetent hosts'''
 :::* In the immunocompetent hosts, symptoms of Cystoisospora infection are usually self-limited.
 :::* Antimicrobial therapy to immunocompetent patients may be considered if symptoms do not start to resolve spontaneously after 5 to 7 days (depending upon severity)
 ::::* Prefered regimen: [[Trimethoprim-sulfamethoxazole]] 160 mg/800 mg PO bid for 7-10 days
-::::* Alternative regimen (for patients who are allergic to or intolerant of TMP-SMX): [[Pyrimethamine]] 50-75 mg/day PO qd or divided in 2 equal doses {{and}} Leucovorin 10–25 mg PO qd
+::::* Alternative regimen (1) (for patients who are allergic to or intolerant of TMP-SMX): [[Pyrimethamine]] 50-75 mg/day PO qd or divided in 2 equal doses {{and}} Leucovorin 10–25 mg PO qd
+::::* Alternative regimen (2): [[Ciprofloxacin]] 500 mg PO bid for 7 days (second-line alternative)
 :* 2. '''Cystoisospora belli prophylaxis'''<ref>{{cite web | title = Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url = https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf }}</ref>