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estinal protozoan infections (parasitic diarrhoea)
– If th e causal ag ent h as been id entified in th e stool:
Giardiasis tinidazole P O as a sing le d ose or metronidazole P O for 3 d ays
C h ild ren: 5 0 m g / kg (m ax.2 g ) C h ildren: 3 0 m g / kg / day in 3 div ided
doses
A d ults: 2 g A d ults: 2 g / jour en une prise
Cryptosporidiosis In im m unocom petent patients, no aetiolog ical treatm ent; spontaneous
resolution in 1 to 2 w eeks.
Cyclosporiasis co-trimoxazole P O for 7 d ays
C h ild ren: 5 0 m g SM X + 1 0 m g T M P / kg / d ay in 2 d iv id ed d oses
A d ults: 1 6 0 0 m g SM X + 3 2 0 m g T M P / d ay in 2 d iv id ed d oses
In im m unocom petent patients, sym ptom s usually resolv e spontaneous in
1 to 3 w eeks. T reatm ent is g iv en in case of sev ere or prolong ed sym ptom s.
Isoporiasis co-trimoxazole P O for 7 to 1 0 d ays
A d ults: 1 6 0 0 to 3 2 0 0 m g SM X + 3 2 0 to 6 4 0 m g T M P / d ay in 2
d iv id ed
d oses
In im m unocom petent patients, sym ptom s usually resolv e spontaneous in
2 to 3 w eeks. T reatm ent is g iv en in case of sev ere prolong ed sym ptom s.
– I f reliable stool exam ination cannot be carried out: parasitic d iarrh oeas cannot be
d ifferentiated on clinical g round s, nor is it possible to d isting uish th ese from non-
parasitic d iarrh oeas. A n em pirical treatm ent (using tinid azole or m etronid azole and
cotrim oxazole as abov e, tog eth er or in succession) m ay be tried in th e case of
prolong ed d iarrh oea or steatorrh oea. I n patients w ith H I V infection, see em pirical
treatm ent, pag e 2 1 3 .
– I n patients w ith ad v anced H I V d isease, cryptosporid iosis, cyclosporiasis and
isosporiasis are opportunistic infections; th e m ost effectiv e interv ention is th e
treatm ent of th e und erlying H I V infection w ith antiretrov irals. P atients rem ain at
h ig h risk for d eh yd ration/ d eath until im m unity is restored .
148
– If th e causal ag ent h as been id entified in th e stool:
Giardiasis tinidazole P O as a sing le d ose or metronidazole P O for 3 d ays
C h ild ren: 5 0 m g / kg (m ax.2 g ) C h ildren: 3 0 m g / kg / day in 3 div ided
doses
A d ults: 2 g A d ults: 2 g / jour en une prise
Cryptosporidiosis In im m unocom petent patients, no aetiolog ical treatm ent; spontaneous
resolution in 1 to 2 w eeks.
Cyclosporiasis co-trimoxazole P O for 7 d ays
C h ild ren: 5 0 m g SM X + 1 0 m g T M P / kg / d ay in 2 d iv id ed d oses
A d ults: 1 6 0 0 m g SM X + 3 2 0 m g T M P / d ay in 2 d iv id ed d oses
In im m unocom petent patients, sym ptom s usually resolv e spontaneous in
1 to 3 w eeks. T reatm ent is g iv en in case of sev ere or prolong ed sym ptom s.
Isoporiasis co-trimoxazole P O for 7 to 1 0 d ays
A d ults: 1 6 0 0 to 3 2 0 0 m g SM X + 3 2 0 to 6 4 0 m g T M P / d ay in 2
d iv id ed
d oses
In im m unocom petent patients, sym ptom s usually resolv e spontaneous in
2 to 3 w eeks. T reatm ent is g iv en in case of sev ere prolong ed sym ptom s.
– I f reliable stool exam ination cannot be carried out: parasitic d iarrh oeas cannot be
d ifferentiated on clinical g round s, nor is it possible to d isting uish th ese from non-
parasitic d iarrh oeas. A n em pirical treatm ent (using tinid azole or m etronid azole and
cotrim oxazole as abov e, tog eth er or in succession) m ay be tried in th e case of
prolong ed d iarrh oea or steatorrh oea. I n patients w ith H I V infection, see em pirical
treatm ent, pag e 2 1 3 .
– I n patients w ith ad v anced H I V d isease, cryptosporid iosis, cyclosporiasis and
isosporiasis are opportunistic infections; th e m ost effectiv e interv ention is th e
treatm ent of th e und erlying H I V infection w ith antiretrov irals. P atients rem ain at
h ig h risk for d eh yd ration/ d eath until im m unity is restored .
148
