PLACEBO-CONTROLLED TRIAL OF COTRIMOXAZOLE FOR CYCLOSPORA INFECTIONS AMONG TRAVELERS AND FOREIGN RESIDENTS IN NEPAL

Cyclospora is a coccidian (previously referred to as cyanobacterium-li ke bodies) that has been implicated in cases of prolonged diarrhoea. T he average duration of symptoms is more than three weeks, and no speci fic treatment has been shown to shorten the illness. A case report sug gested that co-trimoxazole may be effective. Expatriate persons with g astrointestinal complaints and cyclospora detected on examination of f aeces were recruited from two clinics in Kathmandu, Nepal, between May and August, 1994. Participants were assigned in a randomised, double- blinded manner to receive either co-trimoxazole (160 mg trimethoprim, 800 mg sulphamethoxazole) or placebo tablets twice daily for 7 days. O f 40 patients included in the study, 21 received co-trimoxazole and 19 placebo. There were no significant differences between these two grou ps in age, sex, time in Nepal, duration or severity of illness, or pre sence of other enteric pathogens. After 3 days, 71% of patients receiv ing co-trimoxazole still had cyclospora detected, compared with 100% o f patients receiving placebo (p=0.016). After 7 days, cyclospora was d etected in 1 (6%) of 16 patients treated with co-trimoxazole who submi tted stool specimens compared with 15 (88%) of 17 patients receiving p lacebo (p<0.0001). Eradication of the organism was correlated with cli nical improvement. There was no evidence of relapse of infection among treated patients followed for an additional 7 days. Treatment with co -trimoxazole for 7 days was effective in curing cyclospora infection a mong an expatriate population in Nepal.