Managing Cryptosporidiosis

Preferred Management Strategies

• Aggressive oral and/or IV rehydration and replacement of electrolyte loss (AIII), and
• Symptomatic treatment of diarrhea with anti-motility agents (AIII); tincture of opium may be more effective than loperamide (CIII).
• People with HIV not taking antiretroviral therapy should initiate antiretroviral therap to achieve immune restoration to CD4 count >100 cells/mm³ (AII).

General Considerations

• Nitazoxanide 500–1000 mg PO twice daily with food for at least 14 days (CIII) plus optimized antiretroviral therapy, symptomatic treatment, and rehydration and electrolyte replacement, or
• Paromomycin 500 mg PO four times a day for at least 14 to 21 days (CIII) plus optimized antiretroviral therapy, symptomatic treatment, and rehydration and electrolyte replacement

Pregnancy Considerations

• Rehydration and initiation of antiretroviral therapy are the mainstays of initial treatment of cryptosporidiosis during pregnancy, as they are in nonpregnant people (AII).
• Opiate exposure in late pregnancy has been associated with neonatal respiratory depression, and chronic exposure may result in neonatal withdrawal; therefore, tincture of opium is not recommended in late pregnancy (AIII).
• Loperamide is the preferred antimotility agent in late pregnancy (CIII). Loperamide should be avoided in the first trimester unless benefits are felt to outweigh potential risks (CIII).

• Nitazoxanide (CIII) and paromomycin (CIII) can be used in pregnancy after the first trimester.

• Because diarrhea can cause lactase deficiency, people with cryptosporidiosis should avoid milk products (CIII).