CHRONIC CRYPTOSPORIDIOSIS IN PATIENTS WITH AIDS - STABLE REMISSION AND POSSIBLE ERADICATION AFTER LONG-TERM, LOW-DOSE AZITHROMYCIN

Aims-To investigate the effectiveness of long term, low dose azithromy cin treatment for chronic cryptosporidiosis in patients with AIDS. Met hods-Azithromycin was administered as initial daily treatment to 13 pa tients with AIDS: 6 patients received 500 mg for 30 to 40 days (mean 3 5); 3 patients received 1000 mg for 21 to 50 days (mean 37); and 4 pat ients received 1500 mg for 20 days. Nine of the 13 patients were also given low dose maintenance treatment with different schedules of azith romycin for 30 to 360 days (mean 129). Patients were monitored, during and after treatment, for parasite shedding in stool and for daily sto ol frequency and body weight. All but one patient had severe immunodef iciency. Results-Long term, low dose maintenance treatment was associa ted with major clinical and parasitological benefits: there was probab le eradication of infection in 2 patients, and 7 patients showed a com plete response with persistent high decrease (5 patients) or clearance (2 patients) of parasite in stool. The drug was well tolerated, and t here was no relapse either during treatment or during follow up (up to 21 months). These results were more impressive than those observed af ter the short term initial course of azithromycin, which was unable at any tested dose to achieve parasite clearance in stool (except in the patient with less advanced immunodeficiency) or to prevent relapse in 3 patients who discontinued treatment. Reversible side effects occurr ed with the 1500 mg daily dose. Conclusions-Long term, low dose azithr omycin is well tolerated and may induce stable remission of chronic cr yptosporidiosis in patients with AIDS. It may lead to probable eradica tion of the infection in some patients, even those with severe immunod eficiency.