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Paromomycin: an effective treatment for cryptosporidial diarrhea in patients with AIDS

F Bissuel1, L Cotte, M Rabodonirina

  • 1AIDS and Hepatogastroenterology Unit, Hôpital de l'Hôtel-Dieu, Lyon, France.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|March 1, 1994
PubMed

Insights

Oral paromomycin effectively treated chronic diarrhea caused by Cryptosporidium in patients with human immunodeficiency virus (HIV). Most patients experienced remission, with relapses manageable by adjusting paromomycin dosage and maintenance therapy.

Area of Science:

  • Infectious Diseases
  • Gastroenterology
  • Immunology

Background:

  • Cryptosporidiosis is a frequent and challenging opportunistic infection causing diarrhea in individuals with Acquired Immunodeficiency Syndrome (AIDS).
  • Effective treatment options for AIDS-related cryptosporidiosis remain limited, necessitating further therapeutic research.

Purpose of the Study:

  • To assess the efficacy and tolerability of oral paromomycin in treating chronic cryptosporidiosis-induced diarrhea in patients with HIV.
  • To determine the optimal use of paromomycin, including dosage and maintenance therapy, for managing this condition.

Main Methods:

  • An open, uncontrolled, prospective study was conducted.
  • Twenty-four consecutive patients with HIV and chronic diarrhea due to Cryptosporidium infection were enrolled.
  • Oral paromomycin was administered, and clinical response, parasite clearance, and weight changes were monitored.

Main Results:

  • Twenty-two out of 24 patients showed a clinical response, with 18 achieving complete remission and four experiencing significant diarrhea reduction.
  • Cryptosporidia were cleared from stools and/or biopsy specimens within 2-4 weeks in responding patients.
  • Eighteen patients who achieved remission gained weight; relapses occurred in ten but were resolved by adjusting paromomycin therapy.

Conclusions:

  • Oral paromomycin demonstrates activity and good tolerability as a treatment for cryptosporidiosis in patients with AIDS.
  • Treatment efficacy appears dose-related, and continuous maintenance therapy is crucial for preventing relapses.
  • Paromomycin may be a potential first-line therapy for AIDS-related cryptosporidiosis, warranting confirmation through randomized controlled trials.

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