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

A Randomized, Controlled Trial

6 June 2000 | Volume 132 Issue 11 | Pages 885-888

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.

Author and Article Information

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.

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.