Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico

Abstract

A study to evaluate the efficacy and safety of nitazoxanide as a single agent for the treatment of a broad spectrum of mixed parasitic infections, both protozoa and helminths, was conducted at a primary school in San Pedro Tolimán, Querétaro, Mexico. Three faecal samples from 1824 adults and children were screened for the presence of oocysts, cysts, trophozoites, eggs or larvae of intestinal protozoa or helminths. Two hundred and forty-six adults and children infected with at least one protozoan and 2 helminths were given 7.5 mg/kg of nitazoxanide (500 mg to adults and 200 mg to children less than 12 years old) every 12 h for 3 consecutive days. Faecal samples were examined on days 6, 7, 8, 13, 14 and 15 (+/- 1) following initiation of treatment, using formalin-ether concentration and Kato-Katz egg counting. Treatment with nitazoxanide was 71-100% effective in eliminating evidence of infection with Entamoeba histolytica/E. dispar, Giardia duodenalis, Blastocystis hominis, Isospora belli, Enterobius vermicularis, Ascaris lumbricoides, Trichuris trichiura and Hymenolepis nana. Haematology and clinical chemistry values obtained before and after treatment remained unaffected by nitazoxanide. The drug was well tolerated, with only 15 patients (6.1%) reporting mild abdominal pain that lasted less than 24 h.

Nitazoxanide: Nematicidal mode of action and drug combination studies

“…Clinically, NTZ dosed over three days has been shown to act against a wide range of soil-transmitted helminths, including large roundworm Ascaris lumbricoides (69–95% parasitological cure rate), whipworm Trichuris trichiura (76–86% cure rate), the hookworm Ancylostoma duodenale (96% cure rate), and the threadworm Strongyloides stercoralis (94% cure rate)[33, 35]. Since NTZ works via avr-14 , then our results, in combination with the clinical results demonstrate that avr-14 is an excellent target for drug development against a wide range of human STH parasites.…”

“…Reports suggest that NTZ is effective in treating a number of parasitic nematodes, e.g. , the hookworm Ancylostoma duodenale [29, 33], the large roundworm Ascaris lumbricoides [29, 31, 32, 34, 35], the whipworm Trichuris trichiura [29, 31–34] and Strongyloides stercoralis [29, 33]. Successful NTZ treatment regimens for nematode parasites typically involve six doses over two days [33].…”

Liquid chromatography–tandem mass spectrometry analysis of nitazoxanide and its major metabolites in goat

“…The broad spectrum of in vivo activity is related to its desacetyl derivative, tizoxanide, and includes intracellular and extracellular protozoa, helminthes, aerobic and anaerobic bacteria, and virus [1][2][3][4][5][6][7][8]. The Food and Drug Administration has approved this drug in December 2002 for treatment of diarrhea caused by Cryptosporidium parvum and Giardia lamblia, in children 1-11 years of age [9].…”

Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

“…Based on the study previously cited, 13 ciprofloxacin is less effective than TMP-SMX, and nitazoxanide has only been studied in small numbers of HIV-uninfected children and adults. 16 As reviewed above, the relationship between the use of cART and recovery from isosporiasis remains unknown. However, because the incidence of isosporiasis has been reported to be higher in those with more severe immune suppression, it seems reasonable to initiate cART in children with isosporiasis not already receiving cART to prevent recurrence (CIII) .…”