Trimethoprim–Sulfamethoxazole Compared with Ciprofloxacin for Treatment and Prophylaxis of Isospora belli and Cyclospora cayetanensis Infection in HIV-Infected Patients

Trimethoprim–Sulfamethoxazole Compared with Ciprofloxacin for Treatment and Prophylaxis of Isospora belli and Cyclospora cayetanensis Infection in HIV-Infected Patients

A Randomized, Controlled Trial

From Cornell University Medical College, New York, New York, and Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti.

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.

Article and Author Information

Grant Support: In part by the U.S. Public Health Service (R37 AI22624, TW 00018, T32 AI07613, K01 TW00002).
Requests for Single Reprints: Warren D. Johnson Jr., MD, Division of International Medicine and Infectious Diseases, Cornell University Medical College, Room A-421, 1300 York Avenue, New York, NY 10021.
Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
Current Author Addresses: Dr. Verdier: Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, 33 Boulevard Harry Truman, Port-au-Prince, Haiti.
Drs. Fitzgerald, Johnson, and Pape: Division of International Medicine and Infectious Diseases, Cornell University Medical College, Room A-421, 1300 York Avenue, New York, NY 10021.
Author Contributions: Conception and design: R.I. Verdier, W.D. Johnson, J.W. Pape.
Analysis and interpretation of the data: R.I. Verdier, D.W. Fitzgerald, W.D. Johnson, J.W. Pape.
Drafting of the article: R.I. Verdier, D.W. Fitzgerald, W.D. Johnson, J.W. Pape.
Critical revision of the article for important intellectual content: D.W. Fitzgerald, W.D. Johnson, J.W. Pape.
Final approval of the article: R.I. Verdier, D.W. Fitzgerald, W.D. Johnson, J.W. Pape.
Provision of study materials or patients: R.I. Verdier, J.W. Pape.
Statistical expertise: D.W. Fitzgerald
Obtaining of funding: W.D. Johnson, J.W. Pape.
Administrative, technical, or logistic support: D.W. Fitzgerald, W.D. Johnson, J.W. Pape.
Collection and assembly of data: R.I. Verdier, J.W. Pape.