A Cochrane review [Abstract] 1 included 7 trials involving a total of 269 participants. 5 studies enrolled 130 adults with AIDS. Significant heterogeneity was present. There was no evidence for a reduction in the duration or frequency of diarrhoea by nitazoxanide (RR 0.83, 95% CI 0.36 to 1.94, 3 trials, n=166) and paromomycin (RR 0.74, 95% CI 0.42 to 1.31, 2 trials, n= 53) compared with placebo. Nitazoxanide promoted parasitological clearance in HIV-seronegative children RR 0.26 (95% CI 0.09 to 0.80), but not significantly in HIV-seropositive children RR 0.71 (95% CI 0.36 to 1.37). The single study (n=39) comparing spiramycin with placebo in infants found no difference in reduction of the duration of hospitalisation or in mortality.
Comment: The quality of evidence is downgraded by study quality (several limitations), by inconsistency (heterogeneity), and by imprecise results (few patients and wide confidence intervals). The authors of the review state that due to the seriousness of the potential outcomes of cryptosporidiosis, the use of nitaxozanide should be considered in immunocompromised patients.
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