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. Author manuscript; available in PMC: 2014 Nov 1.
Published in final edited form as: Pediatr Infect Dis J. 2013 Nov;32(0 2):i–KK4. doi: 10.1097/01.inf.0000437856.09540.11
Preventive Regimen
Indication First Choice Alternative Comments/Special Issues
Primary Prophylaxis N/A N/A Not recommended
Secondary Prophylaxis Disseminated, Non-Ocular Infection or GI Infection Caused by Microsporidia Other Than E. Bieneusi or V. Corneae:

  • Albendazole 7.5 mg/kg body weight (maximum 400 mg/dose) by mouth twice daily

Ocular Infection:

  • Topical fumagillin bicyclohexylammonium (Fumidil B) 3 mg/mL in saline (fumagillin 70 μg/mL) eye drops: 2 drops every 2 hours for 4 days, then 2 drops QID (investigational use only in United States) plus albendazole 7.5 mg/kg body weight (maximum 400 mg/dose) by mouth twice daily for management of systemic infection

 N/A Criteria For Discontinuing Secondary Prophylaxis:

  • Continue until sustained immune reconstitution (more than 6 months at CDC immunologic category 1 or 2), or

  • After initiation of cART and resolution of signs and symptoms
Treatment Effective cART Therapy:

  • Immune reconstitution may lead to microbiologic and clinical response

For Disseminated (Not Ocular) and Intestinal Infection Attributed to Microsporidia Other Than E. bieneusi or V. corneae:

  • Albendazole 7.5 mg/kg body weight (maximum 400 mg/dose) by mouth twice daily

Treatment Duration:

  • Continue until sustained immune reconstitution (longer than 6 months at CDC immunologic category 1 or 2) after initiation of cART and resolution of signs and symptoms

For E. bieneusi or V. corneae infections:

  • Fumagillin adult dose 20 mg by mouth 3 times daily, or

  • TNP-470 (a synthetic analogue of fumagillin) recommended for treatment of infections due to E. bieneusi in HIV-infected adults

For Ocular Infection:

  • Topical fumagillin bicyclohexylammonium (Fumidil B) 3 mg/mL in saline (fumagillin 70 μg/mL) eye drops: 2 drops every 2 hours for 4 days, then 2 drops QID (investigational use only in United States) plus albendazole 7.5 mg/kg body weight (maximum 400 mg/dose) by mouth twice daily for management of systemic infection

Treatment Duration:

  • Continue until sustained immune reconstitution (longer than 6 months at CDC immunologic category 1 or 2) after initiation of cART and resolution of signs and symptoms.

 N/A

  • Supportive care: Hydration, correct electrolyte abnormalities, nutritional support

  • Fumagillin for systemic use is unavailable in the United States and data on dosing in children are unavailable. Consultation with an expert is recommended.

Key to Acronyms: cART = combination antiretroviral therapy; CDC = Centers for Disease Control and Prevention; GI = gastrointestinal; QID = four times a day