COMBINATION-DRUG THERAPY FOR CRYPTOSPORIDIOSIS IN AIDS

Aside from effective antiretroviral therapy, there is no consistently effective antiparasitic therapy for cryptosporidiosis in AIDS. The pur pose of this study was to assess safety, efficacy, and durability of c ombination therapy with paromomycin and azithromycin for chronic crypt osporidiosis, Patients with AIDS, chronic cryptosporidiosis, and < 100 CD4 cells/mu L were treated with open-label paromomycin (1.0 g twice a day) plus azithromycin (600 mg once a day) for 4 weeks, followed by paromomycin alone for 8 weeks. In 11 patients, median stool frequency decreased from 6.5/day (baseline) to 4.9/day (week 4) and 3.0/day (wee k 12), Median reductions in 24-h oocyst excretion were 84%, 95%, and > 99% at 2, 4, and 12 weeks, respectively. None of the responses were at tributable to antiretrovirals, Of 5 survivors at 12-30 months of follo w-up, 3 remain asymptomatic off medications, and 2 have chronic, mild diarrhea. Treatment of cryptosporidiosis with azithromycin and paromom ycin was associated with significant reduction in oocyst excretion and some clinical improvement.