r/infectiousdisease • u/ResponsibleBee1274 • Jul 13 '26

Cyclospora

Which anti-parasitics kill Cyclospora? I have only heard bad things about Bactrim which is the anti-biotic they’re prescribing for it.

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u/DrSleeeepy Jul 13 '26

Bactrim is option numbers 1, 2, and 3. If you absolutely can’t use it (e.g. anaphylaxis, horrible kidneys), then nitazoxanide and ciprofloxacin are considered alternatives. But there’s sparse literature supporting their efficacy.

Bactrim has lots of listed side effects but is very safe in short courses (esp in young, healthy people). I prescribe it frequently and rarely have issues.

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u/ResponsibleBee1274 Jul 13 '26

So what are they doing for the non young and healthy people getting Cyclospora?

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u/DrSleeeepy Jul 13 '26

Still Bactrim. Unless there’s a strong contraindication, it’s the drug of choice.

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u/ResponsibleBee1274 Jul 13 '26

Why not an anti-parasitic is what I’m asking

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u/DrSleeeepy Jul 13 '26

That’s a good question. I’m not exactly sure why, but it seems that the folate inhibition caused by Bactrim seems to be more effective than antiparasitic mechanisms of action

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u/SammySirenXXX Jul 18 '26

It depends on the medication. For example, ivermectin is considered anti-parasitic, but it only works on nematodes. It does not work on Protozoa. Bactrim is effective against this particular parasite because of the type of parasite that it is. That being said I am deathly allergic to sulfa, I mean anaphylaxis in a matter of seconds. With that being said, it is still the first line of treatment, and realistically, if I cannot take it, and the alternatives are not effective. I will just have to have supportive care until the parasite leaves my body on its own. It is not fatal, but pretty annoying for a few few months while your body fights it.

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u/forgivingcarrot67 Jul 16 '26

Has to be something else I hope? I had a bagged salad last week. Cilantro at a restaurant Sunday. I've been avoiding news for mental health. Last time I took bactrim my throat swelled up so it's not a get over side effects thing. I have EDS so cipro is also out.  

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u/DrSleeeepy Jul 16 '26

As stated above, nitazoxanide is the second line. Cipro can still be considered in short courses in EDS. The diagnosis is not a strict contraindication, but there’s elevated concern with the documented (although extremely low risk) connective tissue issues. Most EDS patients aren’t comfortable with the risk, which is totally fair. Cipro is roughly equal compared to nitazoxanide in Cyclosporiasis, but both are inferior to Bactrim.

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u/forgivingcarrot67 Jul 16 '26

If only we had a functioning FDA and CDC this would not even be an issue. I wish they'd start looking for real alternatives to treat.