Current pharmacotherapy of cryptosporidiosis: an update of the state-of-the-art

ABSTRACT

Introduction: Cryptosporidiosis has emerged as a major cause of diarrheal disease worldwide. It has especially serious health consequences for young, malnourished children living in endemic areas and for individuals with highly impaired T-cell function, such as HIV-positive individuals with low CD4 counts or immunosuppressed solid-organ transplant recipients.

Areas covered: A selective literature search using PubMed was performed to review the available therapeutics to treat cryptosporidiosis, as well as related advances in drug development.

Expert opinion: The only FDA-approved antiparasitic treatment in immunocompetent patients is nitazoxanide; however, it has failed to demonstrate convincing effectiveness among HIV-positive patients, immunosuppressed individuals and malnourished children. Thus, restoring HIV-positive patients’ cellular immune response through effective antiretroviral therapy (ART), or reducing or changing immunosuppressive drugs, is important. Several new targets have been identified for chemotherapy, and the development of drugs for these targets has progressed, including parasite kinases, nucleic acid synthesis and processing, proteases and lipid metabolism. Candidate drugs that have been shown to be effective and safe in a neonatal calf model will most likely constitute the next advance for clinical trials in humans. However, developing an effective and inexpensive vaccination, as well as complementing structural preventive measures, would most decisively reduce the global cryptosporidiosis burden.

KEYWORDS:

• Cryptosporidiosis
• Cryptosporidium
• diarrhea
• treatment
• pharmacotherapy
• protozoa
• HIV

Article highlights

• Cryptosporidium spp. remains a significant cause of diarrheal disease worldwide, especially in developing countries with poor hygiene.

• The only US Food and Drug Administration (FDA)–approved antiparasitic treatment for cryptosporidiosis among immunocompetent patients is nitazoxanide.

• To date, no effective therapy has been licensed for the treatment of cryptosporidiosis among children under one year of age or patients with immunodeficiency.

• Considerable research has examined novel treatment options over the past years, but no potential therapies have yet succeeded in clinical human trials.

• Researchers and clinicians must focus on preventing cryptosporidiosis by avoiding malnutrition, treating HIV patients with antiretroviral therapy (ART), improving environmental factors and developing sufficient hygiene standards.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.