It contains 4 sporozoites and a residium. Thirty-four eastern indigo snakes (Drymarchon couperi) naturally infected with Cryptosporidium serpentis were randomly divided into two groups. Cryptosporidium is a Particularly Challenging Type of Coccidia for Pets. Repurposing of drugs developed for other indications and development of inhibitors for novel targets offer hope for improved therapies, but none have advanced to clinical studies. Expanded Access is a potential pathway for a patient with a serious or immediately life-threatening disease or condition to gain access to an investigational medical product (drug, biologic, or medical device) for treatment outside of clinical trials when no comparable or satisfactory alternative therapy options are available. There is a need for a highly effective treatment for cryptosporidiosis in immunodeficient patients, but the quest for such a drug has proven to be elusive. (2013) reported that Paromomycin to be the more valuable than metronidazole for the treatment of Cryptosporidium infection in cattle based on the clinical trials. Clipboard, Search History, and several other advanced features are temporarily unavailable. You may have unpleasant effects such as headaches, nausea, vomiting, stomach cramps, and warmth or tingling under your skin. Cryptosporidium and Giardia Infections in Children: A Review. Expand current row for information about Alinia, Expand current row for information about nitazoxanide, Expand current row for information about Humatin, Expand current row for information about paromomycin. A Cryptosporidium infection can become chronic if you have a weakened immune system. It may be reasonable to obtain blood cultures in patients with fever and diarrhea (with or without blood), because up to 1% of cases of nontyphoidal Salmonella infections are associated with bacteremia.4,5 Sigmoidoscopy or colonoscopy may be useful in hospitalized patients with bloody diarrhea to obtain tissue and histology, which could aid in the diagnosis. Metronidazole is an antibiotic that is used to treat bacterial infections of the vagina, stomach, liver, skin, joints, brain and spinal cord, lungs, heart, or bloodstream. Has a low potential for abuse relative to those in schedule 4. Side effects may include nausea and a metallic taste in the mouth. Multiple studies support the use of a single dose of ondansetron (Zofran) in children with gastroenteritis-related vomiting.1214 The use of antiemetics in adults with gastroenteritis is reasonable, but data about adverse effects are lacking. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). In cases of suspected foodborne illness or in the setting of an outbreak, stool and vomitus samples should be sent for testing. [ 2 ,3] Fortunately, most dogs infected do not show . Giardiasis is an intestinal infection with the protozoan parasite Giardia spp. doi: 10.1128/AAC.01505-17. There is a lack of accepted safety for use under medical supervision. Antimicrob Agents Chemother. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Anti-Cryptosporidium activity of albendazole, metronidazole, and paromomycin in experimentally infected cattle. Metronidazole is the drug of choice for treating giardiasis - but note cautions with pregnancy and breast-feeding. Immunocompetent persons with cryptosporidiosis have been treated with multiple 3-day courses of nitazoxanide 5. Levinson W, et al. Clostridium perfringens enterotoxicosis in cats is a complex syndrome that causes spontaneous diarrhea in felines. [ 2 ] Most of the time the type of Crypto infection is very specific to the type of animal. You can get cryptosporidiosis from: There are lots of different ways to get cryptosporidiosis, but the main cause of infection is usually from drinking contaminated water or getting water in your mouth at a lake, pool or other public swimming area. Cryptosporidium goes through your mouth into your digestive system, where it reproduces and causes symptoms. You will be subject to the destination website's privacy policy when you follow the link. Watchful waiting is often the most appropriate option in the initial diagnosis and management of foodborne illness; ancillary testing is usually not necessary. Cryptosporidium infections have been reported in humans and in a variety of farm, pet and native animals. People who are in poor health or who have weakened immune systems are at higher risk for more severe and prolonged illness. Do not share this medicine with another person, even if they have the same symptoms you have. U.S. Centers for Disease Control and Prevention. No anti-infective has been found to reliably eradicate Cryptosporidium, although several drugs (e.g., paromomycin, azithromycin, nitazoxanide) appear to suppress the infection. An official website of the United States government. Activity is based on recent site visitor activity relative to other medications in the list. While most cases resolve on their own, theres a risk of life-threatening complications. Two patients' diarrhea stopped following treatment with opiates and metronidazole, given orally in one case and intravenously in the other. If you have cryptosporidiosis, avoid eating or drinking anything that makes diarrhea and dehydration worse, like alcohol and caffeine. It is not known whether these effects would occur in people using this medicine. Nitazoxanide has been approved for treatment of diarrhea caused by Cryptosporidium in people with healthy immune systems. Continue reading, If you are taking oral metronidazole or using metronidazole gel for an infection that is linked with sexual activity, such as trichomoniasis, pelvic inflammatory disease, or bacterial vaginosis you should not have sex for 7 days after single-dose therapy (or until you have completed the 7-day treatment regimen) and your symptoms have resolved. Empiric antibiotic therapy decreases the duration of symptoms in patients with traveler's diarrhea.5,9 Enterotoxigenic E. coli is the most common cause of traveler's diarrhea worldwide and is generally susceptible to ciprofloxacin, but azithromycin (Zithromax) is equally effective and a better choice in areas where fluoroquinolone-resistant C. jejuni is present.9,21 Patients with diarrhea of more than 10 days' duration that is associated with fatty or foul-smelling stools, cramps, bloating, and weight loss can be treated empirically for Giardia infection.22 Because of an increased risk of hemolytic uremic syndrome, patients receiving empiric antibiotic therapy should be monitored closely if Shiga toxinproducing E. coli infection is suspected.4,23, If empiric treatment has not been initiated, antibiotic therapy may be indicated once stool culture, bacterial toxin, or microscopy results are available. If you use a breast pump during this time, throw out the milk and do not feed it to your baby. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. (4) Oral: Unrestricted (green) antibiotic This is not a restricted agent. Next, the body reduces acetaldehyde to acetate using an enzyme called aldehyde dehydrogenase. Metronidazole is the treatment of choice. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use in pregnant women despite potential risks. If you have an underlying condition that weakens you immune system, your provider will help you manage your underlying condition, which can help the symptoms of cryptosporidiosis. Foodborne illnesses are becoming a greater challenge because of new and emerging microorganisms and toxins, the growth of antibiotic resistance, increasing food contamination caused by new environments and methods of food production, and an increase in multistate outbreaks.1 There are more than 250 identified pathogens that cause foodborne illness. E. coli is commonly divided into two broad types, Shiga toxinproducingof which E. coli O157:H7 is the best studiedand non-Shiga toxinproducing, which includes enteropathogenic, enteroinvasive, enteroaggregative, and diffusely adherent E. coli. If you have this condition, stop taking this medicine and contact your doctor if you have signs of liver failure--nausea, stomach pain (upper right side), dark urine, clay-colored stools, or jaundice (yellowing of the skin or eyes). Treatment is aiming for cessation of clinical signs and not for complete elimination of the agent. Would you like email updates of new search results? Make a donation. Contact your healthcare provider if you have symptoms of cryptosporidiosis, especially if you have large amounts of watery diarrhea (several episodes per day). June 25, 2018. Cryptosporidium spp. In someone with a compromised immune system, cryptosporidiosis may never be fully cured and can cause symptoms for years. . This is because metronidazole not only kills the bacteria responsible for conditions such as bacterial vaginosis, but useful bacteria in the vaginal flora that help to keep other microbes in check. Gastroenteritis is infection of the bowels (intestines). Most cases of acute infectious diarrhea are viral, and improper use of empiric antibiotics is associated with increased morbidity caused by adverse effects and Clostridium difficile colitis. Paromomycin used against Cryptosporidiosis under experimental conditions showed better results than albendazole and metronidazole. You may report side effects to FDA at 1-800-FDA-1088. Large clinical trials in humans have never been conducted to confirm this interaction. R01 AI089441/AI/NIAID NIH HHS/United States. Cryptosporidiosis is a disease usually caused by the parasites Cryptosporidium hominis and C. parvum. Manjunatha UH, Chao AT, Leong FJ, Diagana TT. %PDF-1.5 Microorganisms. Version: 15.01. To help diagnose giardia infection (giardiasis), your doctor is likely to test a sample of your stool. Continue reading. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Stool cultures are the diagnostic standard for bacterial foodborne illness; however, culture results are positive in less than 40% of cases. WINTER, DO, AND SCOTT R. CHRISTENSEN, MD. Stool microscopy is rarely diagnostic, but the presence of red and white blood cells may signal a colonic source.4 Its primary use is identification of ova, cysts, and parasites, although antigen testing is more sensitive and specific for Giardia. Most foodborne illnesses are associated with vomiting or diarrhea (more than three loose stools in 24 hours). Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Although these recommendations have been shown to reduce the risk of foodborne illness in the United States, the risk increases with travel. Symptoms of cryptosporidiosis start two to 10 days after youre exposed to Cryptosporidium. Metronidazole (Flagyl . The history is the most important step in evaluating a patient with diarrheal illness (Table 2).5. If you have a compromised immune system, see your healthcare provider right away if you have any symptoms of infectious disease. Treatment with metronidazole (or tinidazole) is followed by a 10-day course of diloxanide furoate. Please enable it to take advantage of the complete set of features! Doumbo O, Rossignol JF, Pichard E, Traore HA, Dembele TM, Diakite M, Traore F, Diallo DA. Please enable it to take advantage of the complete set of features! Nevertheless, it has been >30 years since the introduction of any new innovative treatment and, for some pathogens (including Cryptosporidium), there is currently no accepted specific therapy [].Nitazoxanide, 2-acetyloxy-N-(5-nitro-2-thiazolyl) benzamide (Alinia; Romark . Overdose symptoms may include nausea, vomiting, numbness, tingling, or problems with balance or muscle movement. Cleveland Clinic is a non-profit academic medical center. Healthy dogs were medicated with a 14-day course of metronidazole; more than 50% developed diarrhea during treatment. It had previously been licensed in 2002 for only children aged 1-11 years. How can I avoid spreading cryptosporidiosis? The dose is usually 35 to 50 milligrams (mg) per kilogram (kg) of body weight per day, divided into 3 doses, for 10 days. Nitazoxanide was synthesized in the 1980s by combining a thiazole ring (similar structurally to metronidazole) with a benzamidine ring (similar to the tapeworm drug niclosamide). Some evidence suggests that avoiding foods with lactose (like dairy products) can shorten the amount of time diarrhea lasts. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Metronidazole (25 mg/kg) administered orally, twice a day, for 5 to 7 days was successful in clearing Giardia infections in adult laboratory-reared cats. We comply with the HONcode standard for trustworthy health information. Cryptosporidiosis spreads easily. In recent years, nitazoxanide has been licensed in the United States for the treatment of cryptosporidiosis in non-immunodeficient children and adults, becoming the first drug approved for treating this disease. This includes prescription and over-the-counter medicines, vitamins, and herbal products. This medicine will not treat a viral infection (flu or a common cold). The https:// ensures that you are connecting to the Prevention is the first step in combatting foodborne illnesses. Half of all people living with AIDS will never get rid of Cryptosporidium once infected. About 10% of women report a vaginal yeast infection (vaginal candidiasis) as a side effect of metronidazole treatment. Our results open a new prospective hope for treatment of Cryptosporidium in immunocompromised individuals in addition to its notable effect in improving intestinal dysplasia caused by this infection. Other tests that can be considered include serum chemistry (including albumin levels), C-reactive protein levels, complete blood count, blood cultures, urinalysis, abdominal radiography, anoscopy, and endoscopy, if warranted by the severity and pattern of symptoms.5 In severe cases of infectious diarrhea, toxic megacolon should be considered, which can be identified on plain abdominal radiography.4 Severe inflammatory changes can also be seen on computed tomography. Fox LM, Saravolatz LD. and transmitted securely. For oral dosage forms (capsules or tablets): For amebiasis infections: Adults500 or 750 milligrams (mg) 3 times a day for 5 to 10 days. New potentially promising drug targets in Cryptosporidium and Giardia have been identified, but there appears to be little activity toward clinical development of new drugs. Yes 1, 2. A positive stool culture is more likely when analysis indicates an inflammatory process. Cryptosporidium is considered a common, contagious parasite in dogs and other animals. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Alinia, For professionals: Leder K, et al. Symptoms in people with normal immune systems usually last for about 1 to 2 weeks. It spreads easily in kids because they dont yet have good hand washing habits or understand how germs spread. How long does it take for metronidazole to work? Physicians should avoid attributing cases of foodborne illness to specific food sources without definitive testing and reporting. Moreover, Metronidazole was found more effective than paromomycin in naturally infected lambs and kids (Shafiq et al ., 2015). Stool tests may also be used to monitor the effectiveness of any treatment you receive. dosage, interactions, side effects, Brand name: Pediatr Clin North Am. A new study published this year in the Journal of Veterinary Internal Medicine calls attention to metronidazole's dramatic effects on the canine gut microbiome. Cleveland Clinic is a non-profit academic medical center. Generic name: metronidazole (oral/injection) In some animals, particularly ruminants but also wild mammals, Giardia infection commonly occurs without overt or apparent clinical signs. Protozoal Intestinal Infections and Trichomoniasis. The dormant (inactive) form of Cryptosporidium , called an oocyst . oocysts were spherical to ovoid in shape with smooth wall. INTRODUCTION. government site. Has no currently accepted medical use in treatment in the United States. Drink unfiltered or untreated water (often while traveling, hiking or camping). Acetate is easily oxidized by our body into carbon dioxide (CO2), which we then breathe out. Abboud P, Leme V, Gargala G, Brasseur P, Ballet JJ, Borsa-Lebas F, Caron F, Favennec L. Clin Infect Dis. Metronidazole systemic 500 mg (PLIVA 334). This can result in an . Persistent symptoms may also represent re-infection or other causes of illness besides cryptosporidiosis. Nitazoxanide appears to be well tolerated and different treatment regimens have been used for a variety of infections. While not effective against Cryptosporidium, nitroimidazoles such as metronidazole or tinidazole are effective treatments for giardiasis and can be administered as a single dose. Giacometti A, Burzacchini F, Cirioni O, Barchiesi F, Dini M, Scalise G. Eur J Clin Microbiol Infect Dis. 2022 Dec;46(4):1133-1146. doi: 10.1007/s12639-022-01513-2. When signs and symptoms are severe or the infection persists, doctors usually treat giardia infection with medications such as: Metronidazole (Flagyl). On the other hand, Masood et al. It causes watery diarrhea that can be severe. ACS Infect Dis. Clin Infect Dis. metronidazole antabuse effect. Editorial Note: Cryptosporidium is a protozoan parasite; it is a well recognized . Guidelines for safely handling and preparing food should be followed regardless of the setting in which food is consumed. a light-headed feeling (like you might pass out); blisters or ulcers in your mouth, red or swollen gums, trouble swallowing. Diagnosis and management of a foodborne illness are based on the history and physical examination. Accessed Nov. 3, 2020. Advertising on our site helps support our mission. Metronidazole is an antimicrobial medication that has antiprotazoal . The oocysts of C. canis and C. felis are infectious when passed and are moderately resistant to environmental extremes and the routine levels of chlorine occurring in water. Cryptosporidium (crip-toe-spor-ID-ee-um) is a protozoan, a single-celled, microscopic pathogenic (disease causing) parasite that lives in the intestines of animals and people. is responsible for approximately 7.6 million cases and between 48 000 and 202 000 deaths annually among young children in low-resource settings.Beyond acute morbidity and mortality, both symptomatic and . Since you can still spread cryptosporidiosis even once your symptoms are gone, ask your employer or school when you or your child can come back. Qin SY, Sun HT, Lyu C, Zhu JH, Wang ZJ, Ma T, Zhao Q, Lan YG, He WQ. 2004 Feb;2(1):43-9. doi: 10.1586/14787210.2.1.43. It is most commonly seen in children aged between 1 and 5 years. Saving Lives, Protecting People, Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-Exposed and HIV-Infected Children, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), General Information for Immunocompromised Persons, Prevention & Control Immunocompromised Persons, Prevention & Control Childcare Facilities, Responding to Crypto Outbreaks at Childcare Facilities, Hospitals, Healthcare Facilities, & Nursing Homes, A Guide to Commercially-Bottled Water and Other Beverages, Information for Immunocompromised Persons, Information for Public Health & Medical Professionals, Water, Sanitation, & Environmentally-related Hygiene, U.S. Department of Health & Human Services. FOIA He or she may also check your mouth and skin for signs of dehydration. Ways to reduce your risk of getting and spreading cryptosporidiosis include: For most people, cryptosporidiosis is self-limiting, meaning it will go away on its own. Get useful, helpful and relevant health + wellness information. Diarrhea within 24 hours of ingestion is most likely caused by C. perfringens or B. cereus. If your sexual partners are also being treated, then abstain from sexual intercourse until they have finished treatment. In addition, it has anti-inflammatory properties in the large intestine and is an effective anti-diarrhea medication. Do not take two doses at one time. 1999 Dec;18(12):885-9. doi: 10.1007/s100960050424. Your provider may prescribe oral or IV hydration or antidiarrheal medications. . Parasitologic cure rate was a key consideration in developing prevention recommendations that ask people to refrain from swimming for 2 weeks after resolution of symptoms. Sometimes it is not safe to use certain medicines at the same time. Has a potential for abuse less than those in schedules 1 and 2. Dogs get infected with Cryptosporidium canis, while cats get C. felis and humans get C. parvum and C.hominis . Cryptosporidium is a protozoan parasite a one-celled organism that lives off of animals and people. Policy. Federal government websites often end in .gov or .mil. Clinical cure (resolution of diarrhea) rates range from 72-88% 1. Acid fast stain - for Giardia & Cryptosporidium; Treatment of intestinal parasites. Has a low potential for abuse relative to those in schedule 3. All Rights Reserved. Treatment options include: Ponazuril (20-50 mg/kg PO Q 24 H for 1-3 days*), a direct . Has a high potential for abuse. Not all possible drug interactions are listed here. <> Author disclosure: No relevant financial affiliations. Tell your provider if you have liver or kidney disease, bile or gallbladder problems or a weakened immune system before taking nitazoxanide. Cryptosporidiosis is an illness you get from the parasite Cryptosporidium. 16th ed. Take care of someone who has cryptosporidiosis. Giardiasis: Treatment and prevention. Water, broth, sports drinks or oral rehydration solutions (like Pedialyte) are the best choices to keep you hydrated. Cryptosporidiosis Outbreaks United States, 20092017. Last reviewed by a Cleveland Clinic medical professional on 08/24/2022. Eat small bites of food if youre able to. First, it breaks alcohol down into a compound called acetaldehyde. Thank you for taking the time to confirm your preferences. DOC for entamoeba histolytica, giardias, trichomoniasis kills trophozoites but not cysts treatment usually followed by luminal drug to eliminate asymptomatic infection mechanism involves ETC Tinidazole is an alternative with less toxicity. cryptosporidium treatment metronidazole. Ranasinghe S, Zahedi A, Armson A, Lymbery AJ, Ash A. Pathogens. Consumer information on food safety is available from the CDC at http://www.cdc.gov/foodsafety/facts.html or from the U.S. Food and Drug Administration at http://www.fda.gov/Food/FoodborneIllnessContaminants/FoodborneIllnessesNeedToKnow/default.htm or http://www.foodsafety.gov, or by calling (888) SAFEFOOD ([888] 7233366). Immune reconstitution or decreased immunosuppression is critical to therapy in AIDS and transplant patients. 2005 40(8):1173-80. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Before While you may initially bring your symptoms to the attention of your family doctor, he or she may refer you to a gastroenterologist a doctor who specializes in digestive system disorders. Metronidazole is usually given for up to 10 days in a row. Abdominal cramps, nausea, watery diarrhea, Abdominal cramps, diarrhea (may be bloody), fever, vomiting, Contaminated water, raw or undercooked poultry, unpasteurized milk, Blurred vision, diarrhea, difficulty swallowing, double vision, muscle weakness, vomiting; can cause respiratory failure and death, Fermented fish, improperly canned foods (especially home-canned vegetables), potatoes baked in aluminum foil, Intense abdominal cramps, watery diarrhea, Dried or precooked foods, gravy, meats, poultry, undercooked foods, Abdominal cramps, diarrhea (usually watery), slight fever, May be remitting and relapsing over weeks to months, Contaminated drinking water, cooked foods that are not reheated after contact with an infected food handler, uncooked foods, Abdominal cramps, diarrhea (usually watery), fatigue, loss of appetite, nausea, substantial weight loss, vomiting, Contaminated raw produce (e.g., basil, imported berries, lettuce), Abdominal cramps, vomiting, watery diarrhea, Food or water contaminated with human feces, Abdominal pain, severe diarrhea (often bloody), vomiting; can cause kidney failure, Contaminated drinking water, contaminated raw produce (e.g., sprouts), undercooked beef (especially hamburger), unpasteurized milk or juice, Abdominal pain, dark urine, diarrhea, fever, headache, jaundice, nausea, Contaminated drinking water, contaminated raw produce, cooked foods that are not reheated after contact with an infected food handler, shellfish from contaminated water, uncooked foods, 9 to 48 hours for gastrointestinal symptoms, 2 to 6 weeks for invasive disease, Diarrhea, fever, muscle aches, nausea; pregnant women may have mild flulike illness, and infection can lead to premature delivery or stillbirth; older adults and immunocompromised patients may develop bacteremia or meningitis, Deli meats, unpasteurized milk, soft cheeses made with unpasteurized milk, Norovirus (food poisoning, viral gastroenteritis, winter diarrhea), Abdominal cramps, diarrhea (more common in adults), fever, headache, nausea, vomiting (more common in children), Abdominal cramps, diarrhea, fever, vomiting, Cheese, contaminated raw produce, eggs, meat, poultry, unpasteurized milk or juice, Abdominal cramps, diarrhea, fever; stools may contain blood and mucus, Contaminated drinking water, contaminated raw produce, cooked foods that are not reheated after contact with an infected food handler, uncooked foods, Abdominal cramps, diarrhea, fever, sudden onset of severe nausea and vomiting, Unrefrigerated or improperly refrigerated cream pastries, meats, and potato or egg salad, Abdominal cramps, fever, nausea, vomiting, watery diarrhea (occasionally bloody), Abdominal pain, bleeding under the skin, bloodborne infection, diarrhea, fever, ulcers requiring surgical removal, vomiting; can be fatal to persons with liver disease or weakened immune systems, Undercooked or raw seafood (especially oysters), Acute abdominal pain, fever, and vomiting, Together, these symptoms raise suspicion for infectious diarrhea, Recent changes in diet and ingestion of foods included in recent recalls or undercooked foods should raise suspicion for foodborne illness, Longer duration raises concern for dehydration, Persons who work at child care centers or in close contact with others are at risk of viral diarrhea, Cross-contamination and transmission of pathogens are possible; may help narrow differential if cause is known in the other person, Hospitalization or nursing home admission, Raises suspicion for atypical causes of diarrhea, Can help determine possible comorbidities that suggest a cause, Stool characteristics (bloody, foul smelling, watery), Foul-smelling stools in patients with recent hospitalization or antibiotic use raise suspicion for, Watery stools raise suspicion for viral cause or, Travel to foreign countries, especially non-Western countries, should raise suspicion for infectious diarrhea, Decreased appetite, fever, jaundice, nausea, right upper-quadrant abdominal pain, vomiting, CBC, C-reactive protein level, liver function testing, right upper-quadrant ultrasonography, Abdominal pain, arthralgias, arthritis, fever, jaundice, malaise, nausea, vomiting, Ammonia levels, hepatitis panel, liver biopsy, liver function testing, ultrasonography, Fever, left lower-quadrant abdominal pain, Abdominal CT, CBC; contrast enema and colonoscopy may be considered, Abdominal pain, chronic diarrhea, occasional bloody diarrhea, weight loss, Colonoscopy with tissue biopsy, negative stool culture, Abdominal pain, diarrhea, hematochezia, melena, weight loss, Abdominal CT, arterial blood gas levels, blood chemistry panel, CBC, colonoscopy, electrocardiography, lactate levels, magnetic resonance angiography, Abdominal pain, anorexia, diarrhea, fever, nausea, vomiting, Diagnosis is generally clinical; may be confirmed by antigen-detecting enzyme immunoassay, immunofluorescence assay, microscopy, polymerase chain reaction testing, serology, or viral culture (although routine use of these tests is not necessary), Erythromycin, 500 mg 2 times per day for 5 days, Azithromycin, 10 mg per kg per day for 3 to 7 days, Azithromycin (Zithromax), 500 mg on day 1, then 250 mg on days 2 through 5, Ciprofloxacin, 500 mg 2 times per day for 3 days, TMP-SMX, 5/25 mg per kg 2 times per day for 3 days, TMP/SMX, 160/800 mg 2 times per day for 3 to 7 days, Azithromycin, 500 mg on day 1, then 250 mg on days 2 through 5, Ciprofloxacin, 500 mg 2 times per day for 5 to 7 days, TMP-SMX, 5/25 mg per kg 2 times per day for 5 to 7 days, Ceftriaxone, 1 to 2 g per day intramuscularly or intravenously for 5 to 7 days, Ceftriaxone, 50 to 100 mg per kg per day intramuscularly or intravenously for 5 to 7 days, Metronidazole (Flagyl), 750 mg 3 times per day for 5 to 10 days, Metronidazole, 30 to 50 mg per kg per day in 3 divided doses for 7 to 10 days, Paromomycin, 500 mg 3 times per day for 7 days, or iodoquinol (Yodoxin), 650 mg 3 times per day for 7 days, Paromomycin, 25 to 35 mg per kg per day in 3 divided doses for 5 to 10 days, Metronidazole, 250 to 750 mg 3 times per day for 7 to 10 days.