Key points
- Most patients with no underlying medical conditions will eventually recover from cyclosporiasis without treatment, although their illness may be prolonged.
- Trimethoprim-sulfamethoxazole (TMP-SMX) is the treatment of choice for cyclosporiasis.
- No vaccine for cyclosporiasis is available.
Treatment options
Trimethoprim-sulfamethoxazole (TMP-SMX)(sold as Bactrim,A Septra,A or CotrimA) is the treatment of choice for cyclosporiasis.
TMP 160 mg plus SMX 800 mg (one double strength tablet), orally, twice a day, for 7–10 days.
Patients with weakened immune systems may need longer courses of therapy.
Dosage for pediatric patients ≥2 months to 18 years
8–10 mg/kg TMP and 40–50 mg/kg SMX per day, orally, in 2 divided doses for 7–10 days.
Most patients who have healthy immune systems will recover without treatment. If not treated, the illness may last from a few days to a month or longer. Symptoms may seem to go away and then return one or more times (relapse).
Alternative treatments
No highly effective alternatives have been identified for patients who are allergic to (or are intolerant of) TMP-SMX. Approaches to consider for such patients include:
- Observation and symptomatic treatment
- Use of nitazoxanide and ciprofloxacin—if treatment with TMP-SMX is not feasible
- Effectiveness of either alternative drug is uncertain due to limited evidence and lack of robust clinical trials, especially in immunocompetent patients with cyclosporiasis
- See Resources for alternative treatments
- Desensitization to TMP-SMX
- This approach should be considered only for selected patients who require treatment, have been evaluated by an allergist, and do not have a life-threatening allergy
Ineffective drugs
Anecdotal or unpublished data suggest that the following drugs are ineffective:
- Albendazole
- Azithromycin
- Diloxanide furoate
- Doxycycline
- Metronidazole
- Nalidixic acid
- Quinacrine
- Tetracycline
- Tinidazole
- Trimethoprim (when used as a single agent)
Ciprofloxacin
Data from a small study among people living with HIV in Haiti suggested that ciprofloxacin might have modest activity against Cyclospora. Still, substantial anecdotal experience among many immunocompetent persons suggests that ciprofloxacin is ineffective.
Care precautions
Pregnant patients
Because TMP-SMX may interfere with folic acid metabolism, TMP-SMX should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus (Food and Drug Administration). Neonatal care providers should be informed if maternal sulfa therapy was used near delivery because of the theoretical increased risk of hyperbilirubinemia and kernicterus in the newborn (National Institutes of Health).
Lactating patients
TMP-SMX is excreted in breast milk. TMP-SMX generally is compatible with breastfeeding of healthy, full-term infants after the newborn period. However, TMP-SMX generally should be avoided by women when nursing infants who are premature, jaundiced, ill, or stressed, or who have glucose-6-phosphate dehydrogenase deficiency.
Pediatric patients
The safety of TMP-SMX in children has not been systematically evaluated. Use in children less than 2 months of age generally is not recommended.
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