Nitazoxanide for Treatment of Refractory Bony Hydatid Disease

Abstract

Although nitazoxanide has been shown to have activity against Echinococcus multilocularis in animal studies and against E. granulosus in vitro, its use in treatment of human cystic echinococcosis has not been reported. We report a case of progressive bony hydatid disease treated with nitazoxanide that showed a clinical and radiologic response. The patient had a 40-year history of hydatid disease involving the left hip. Despite prolonged courses of albendazole and praziquantel, she had progressive disease with extensive involvement of the left hemipelvis and adjacent soft tissue cysts. She was treated with nitazoxanide, 500 mg twice a day for 3 months in combination with albendazole. The clinical response was supported by imaging showing marked improvement in the soft tissue cysts, with stable disease in the bony pelvis. Although further studies are required, this case suggests that nitazoxanide may be an effective treatment option in hydatid disease, particularly in patients with progressive disease who are receiving conventional therapy.

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.…”

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

“…We report data on seven cases: two from the literature 24,25 and five from our hospital ( Table 1 ). Median patient age was 45 years (range 27-68 years) with a male to female ratio of 2.5:1.…”

“…One subject was treated for 15 days only because of gastrointestinal intolerance (case 6). For the other six patients, length of therapy ranged from 3 months (two patients, with an additional month in case 1 25 ), to 24 months. In two out of those six patients (cases 3 and 5), nitazoxanide was discontinued after 18 and 24 months of therapy, respectively, given that neither clinical nor radiological responses were clearly obtained.…”

Vertebral echinococcosis leading to spinal cord compression

“…It should be administered long-term on continuous or cycling regimen and may be used alone or in combination with other agents, i.e. praziquantel or nitazoxanide [5]. As illustrated by our case, spinal CE recurrences are frequent and causative of debilitating neurologic complications.…”