Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

immunocompetent

1st line – supportive therapy

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ACUTE
|
immunocompetent
1st line – 

supportive therapy

Disease is self-limiting in immunocompetent patients. Symptoms usually resolve in 7 to 14 days, although they may last for 3 to 4 weeks (in cases seeking medical attention the mean is 13 days, median 11 days).[38] Improvement is followed by brief recurrence of symptoms in about one third of cases.[38][73]

No treatment is normally required, other than measures to prevent dehydration, such as oral rehydration solution.

Consider – nitazoxanide

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ACUTE
|
immunocompetent
|
persistent symptoms
Consider – 

nitazoxanide

Additional treatment recommended for SOME patients in selected patient group

If treatment is required (e.g., when symptoms persist), nitazoxanide can be prescribed for immunocompetent patients ≥1 year old and is well tolerated.[69]​ Even with treatment, it takes up to 5 days for diarrhoea to resolve in 80% of cases.[86]

Where there is little improvement, patients have been treated with multiple 3-day courses of nitazoxanide, and 7-day courses have also been used.[87][88][89]

There are no definitive criteria for when treatment should be instituted, and treatment is not mandatory even if diarrhoea lasts for >7 days; however, some physicians choose to treat the infection as soon as it is diagnosed.

Primary options

nitazoxanide: children 1 to 3 years of age: 100 mg orally twice daily for 3 days; children 4 to 11 years age: 200 mg twice daily for 3 days; children ≥12 years and adults: 500 mg orally twice daily for 3 days

immunocompromised

1st line – treatment of primary disorder

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ACUTE
|
immunocompromised
1st line – 

treatment of primary disorder

Patients at high risk of severe cryptosporidiosis include those with HIV infection, leukemia, and lymphoma (particularly children), or those with primary T-cell immune deficiency.

Usually only improvement in the underlying immune condition results in significant improvement.

In patients with HIV infection, antiretroviral therapy is the treatment of choice.[90][91]​ As well as improving the level of CD4 cells and restoring a degree of immunity, protease inhibitors reduce host-cell invasion by Cryptosporidium sporozoites and parasite development in vitro.[92]

In other types of immune deficiency, improving immunity where possible can also lead to improvement.[93]

Plus – supportive therapy

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ACUTE
|
immunocompromised
Plus – 

supportive therapy

Treatment recommended for ALL patients in selected patient group

In severe cases of cryptosporidiosis, supportive treatment may be required; this may include intravenous rehydration and correction of electrolytes if much fluid loss has occurred.

Plus – nitazoxanide

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ACUTE
|
immunocompromised
|
refractory and/or severe disease
Plus – 

nitazoxanide

Treatment recommended for ALL patients in selected patient group

Nitazoxanide is not approved to treat immunocompromised patients, as it has not been shown to be superior to placebo in these patients. In the face of disease in an immunocompromised patient, which may be fatal if refractory and/or severe, clinicians may nonetheless elect to use nitazoxanide.

In patients with HIV infection, nitazoxanide (14-day course) may be used in conjunction with antiretroviral therapy.[90][91]​​​[94]

Some clinicians experienced in the management of immunocompromised patients with severe or life-threatening cryptosporidiosis advocate the combination of nitazoxanide, paromomycin, and azithromycin. However, the evidence for their efficacy is weak, and they are not licensed for this indication.[102][103][104]​​

Primary options

nitazoxanide: children 1 to 3 years of age: 100 mg orally twice daily for 3-14 days; children 4 to 11 years of age: 200 mg twice daily for 3-14 days; children ≥12 years of age: 500 mg orally twice daily for 3-14 days; adults: 500-1000 mg orally twice daily for 14 days

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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