Evaluation of Nitazoxanide for the Treatment of Disseminated Cystic Echinococcosis: Report of Five Cases and Literature Review

Abstract

We aimed to evaluate the effectiveness of nitazoxanide in disseminated cystic echinococcosis (DCE) that failed to respond to surgical and antiparasitic therapy. We report on seven patients (five of them with bony involvement): two cases from the literature and five patients who were included in a compassionate trial of nitazoxanide therapy in our hospital. Median follow-up time until nitazoxanide therapy was 12 years and all patients had received prior medical treatment and extensive surgery. Nitazoxanide (500 mg/12 h) in combination with albendazole, with/without praziquantel, was administered for 3–24 months. Three patients improved: one with muscle involvement (clinico-radiological response), one with lung involvement (radiological response), and another with soft tissue and bony involvement (clinico-radiological response of soft tissue cysts). There was one discontinuation after 15 days of starting therapy. Nitazoxanide combination therapy could have a role in the treatment of DCE when there is no bony involvement. Long-term safety profile seems to be favorable.

Safety of the Combined Use of Praziquantel and Albendazole in the Treatment of Human Hydatid Disease

“…The use of nitazoxanide in combination with albendazole, with or without praziquantel, appears to be useful in this type of case. 16,46 In our series there was an obvious selection bias, because all patients were hospitalized and no outpatients were included (who generally present a less aggressive hydatidosis), and of course without bearing in mind carriers of asymptomatic of hydatid cysts, which have not even been diagnosed. This would suggest the existence of an over dimension of severe cases in our series.…”

“…[19][20][21][22] Over the past few decades, other anthelmintic chemotherapies such as praziquantel and nitazoxanide have also been tested against Echinococcus spp., but their efficacies are inferior to those of benzimidazoles. 16,23,24 Despite this, the combination of albendazole with praziquantel has shown synergistic activity against Echinococcus spp. In fact, observational studies suggest that the combined therapy could improve the cure rates obtained with albendazole alone [23][24][25][26] ; regarding the safety of medical therapy, an increase in transaminases levels is the most frequent adverse reaction related to albendazole treatment, 27 whereas digestive symptoms are the most frequent adverse effects associated with praziquantel in monotherapy.…”

“…Accordingly, because of the contraindications and complications of invasive procedures, in recent years medical therapy has gained ground over the other choices. [16][17][18] Medical treatment is usually indicated before surgery to diminish the size of hydatid cysts, to sterilize them, and to avoid relapses. In addition, medical treatment is the sole therapeutic option in disseminated hydatidosis.…”

Two cases of femoral hydatidosis secondary to canine tapeworm treated by albendazole and prosthetic reconstruction

“…In case 1, praziquantel chemotherapy induced abdominal discomfort and intolerance and provoked increased seric levels of γ-GT. Adjunction of a third drug (nitazoxanide), as advocated in the oral treatment of hydatid disease, does not appear to be a good option as nitazoxanide is not active in bone tissue 25. However, further studies are necessary to evaluate the efficacy and safety of the drug associations on the long term.…”

Echinococcosis/Hydatidosis

“…Other drugs as nitazoxamide (at doses of 500mg/12h for 3-24 months) has been evaluated in the effectiveness in disseminated cystic echinococcosis (DCE) that failed to respond to surgical and antiparasitic therapy. Three patients improved: one with muscle involvement (clinico-radiological response), one with lung involvement (radiological response), and another with soft tissue and bony involvement (clinico-radiological response of soft tissue cysts) (Pérez-Molina et al, 2011). Benzimidazoles are contraindicated in pregnancy because they are teratogenic.…”