Chemotherapy of human and animal coccidioses: state and perspectives

The state and perspectives for chemotherapy of cyst-forming and non-cyst-forming coccidia in humans and animals are summarized. In toxoplasmosis the therapeutic care of transplacental infections, which have gone out of control because of immunodeficiency, is in the forefront of attempts at improvement. Predominant drugs in use are pyrimethamine combined with a sulfonamide or with clindamycin, or trimethoprim plus sulfamethoxazole. For reasons of tolerability in human immunodeficiency virus (HIV)-infected patients, after 3 months of therapy a maintenance treatment on 2 days a week has recently given very positive results. In cats, monensin and toltrazuril are effective against the intestinal developmental stages of Toxoplasma gondii, the later drug affecting to a reasonable extent the extraintestinal stages as well. Attempts to treat neosporosis and sarcocystosis remain in the initial stages. The same is true for cryptosporidiosis in humans and animals. A number of highly effective drugs are available for prophylaxis of poultry coccidiosis. Increasing problems with resistance have led to new treatment schemes such as shuttle and rotation programs. In addition to a new polyether, semduramycin, a benzeneacetonitrile derivative (diclazuril) has been developed in recent years. After three decades a new drug (toltrazuril), a symmetrical triazinone derivative, has brought improvements for therapy and/or metaphylaxis in coccidiosis of poultry and mammals. The increasing possibilities for vaccination may result in new aspects for the use of chemotherapeutics, i.e., new combinations and/or shuttle or rotation programs.