IDSA Recommendations for Treating Isospora belli Infection in HIV-AIDS

Treating Isospora belli Infection

General Management Considerations:

 • Fluid and electrolyte support in patients with dehydration 

 • Nutritional supplementation for malnourished patients 

Preferred Therapy for Acute Infection:

 • TMP-SMX (160 mg/800 mg) PO (or IV) QID for 10 days or

 • TMP-SMX (160 mg/800 mg) PO (or IV) BID for 7–10 days

 • One approach is to start with TMP-SMX (160 mg/800 mg) BID regimen first, and increase daily dose and/or duration (up to 3–4 weeks) if symptoms worsen or persist 

 • IV therapy for patients with potential or documented malabsorption

Alternative Therapy For Acute Infection (For Patients with Sulfa Intolerance):

 • Pyrimethamine 50–75 mg PO daily + leucovorin 10–25 mg PO daily or

 • Ciprofloxacin 500 mg PO BID for 7 days 

Chronic Maintenance Therapy (Secondary Prophylaxis) (In Patients with CD4 Count <200/mm3)

Preferred Therapy:

 • TMP-SMX (160 mg/800 mg) PO 3 times weekly (AI)

Alternative Therapy:

 • TMP-SMX (160 mg/800 mg) PO daily or

 • TMP-SMX (320 mg/1600 mg) PO 3 times weekly or

 • Pyrimethamine 25 mg PO daily + leucovorin 5–10 mg PO daily 

 • Ciprofloxacin 500 mg PO 3 times weekly (CI) as a second line alternative

Criteria for Discontinuation of Chronic Maintenance Therapy:

 • Sustained increase in CD4 count >200 cells/mm3 for >6 months in response to ART and without evidence of active I. belli infection



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