Randomized clinical study of nitazoxanide compared to metronidazole in the treatment of symptomatic giardiasis in children from Northern Peru

Ortiz, Juan Jave; Ayoub, Ayman; Gargala, Gilles; Chegne, Nicholas Lopez; Favennec, Loïc

doi:10.1046/j.1365-2036.2001.01066.x

Cited by 98 publications

(41 citation statements)

References 29 publications

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“…Also increasing is extensively drugresistant (XDR) TB caused by strains of M. tuberculosis that are also resistant to the second-line quinolones and injectable aminoglycoside and peptide antibiotics (7,8). The discovery of new TB drugs is therefore a public health priority (9, 10).Nitazoxanide (NTZ) (Alina; Romark Laboratories) is a widely used anti-infective that is remarkable for both the breadth of its clinical indications and its record of safety (11,12). NTZ, a synthetic nitrothiazolyl salicylamide, is deacetylated in the gastrointestinal tract to the active metabolite tizoxanide (13,14).…”

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confidence: 99%

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Efficacy of Nitazoxanide against Clinical Isolates of Mycobacterium tuberculosis

Shigyo

Ocheretina

Merveille

et al. 2013

Antimicrob Agents Chemother

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c Nitazoxanide (NTZ) has bactericidal activity against the H37Rv laboratory strain of Mycobacterium tuberculosis with a MIC of 16 g/ml. However, its efficacy against clinical isolates of M. tuberculosis has not been determined. We found that NTZ's MIC against 50 clinical isolates ranged from 12 to 28 g/ml with a median of 16 g/ml and was unaffected by resistance to first-or second-line antituberculosis drugs or a diversity of spoligotypes.T reatment of drug-sensitive tuberculosis (TB) currently involves treatment with four drugs for 2 months and two drugs for another 4 months. Failure to adhere to this regimen or ingestion of diluted or counterfeit drugs may lead to emergence of drug-resistant TB. TB most often occurs in resource-poor settings that lack the health care system necessary to ensure adherence (1, 2). HIV infection increases the risk for developing active TB and is fueling the TB epidemic, particularly in places where both infections are prevalent. TB remains one of the leading causes of death in AIDS patients, and treatment of TB in such patients requires longer duration of therapy and is associated with a high recurrence rate.Moreover, primary drug-resistant TB is rarely recognized as such when patients first present, owing to the lack of facilities for drug sensitivity testing (DST). As a consequence, multidrug-resistant (MDR) TB, defined as Mycobacterium tuberculosis disease that is resistant to the first-line drugs isoniazid and rifampin, is increasing in prevalence (3-6). Also increasing is extensively drugresistant (XDR) TB caused by strains of M. tuberculosis that are also resistant to the second-line quinolones and injectable aminoglycoside and peptide antibiotics (7,8). The discovery of new TB drugs is therefore a public health priority (9, 10).Nitazoxanide (NTZ) (Alina; Romark Laboratories) is a widely used anti-infective that is remarkable for both the breadth of its clinical indications and its record of safety (11,12). NTZ, a synthetic nitrothiazolyl salicylamide, is deacetylated in the gastrointestinal tract to the active metabolite tizoxanide (13,14). NTZ is approved for the treatment of giardiasis and cryptosporidiosis (15, 16) and has broad-spectrum activity against other protozoa, helminths, and the anaerobic or microaerophilic bacteria Clostridium difficile and Helicobacter pylori, as well as showing effectiveness in infections caused by rotavirus and hepatitis C (14, 17-22).It was recently reported that NTZ and tizoxanide killed the H37Rv reference strain of M. tuberculosis in vitro, both when M. tuberculosis was replicating and when its replication was blocked by physiologic conditions of acidity and nitrosative stress (23). The ability of a given compound to kill both replicating and nonreplicating M. tuberculosis is uncommon (24). The mycobactericidal activity of NTZ was both dose and time dependent but minimally inoculum dependent (23). No resistant mutants were identified in multiple experiments that implied a frequency of resistance of Ͻ10 Ϫ13 , suggesting that nitazoxanide...

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confidence: 99%

“…Nitazoxanide (NTZ) (Alina; Romark Laboratories) is a widely used anti-infective that is remarkable for both the breadth of its clinical indications and its record of safety (11,12). NTZ, a synthetic nitrothiazolyl salicylamide, is deacetylated in the gastrointestinal tract to the active metabolite tizoxanide (13,14).…”

mentioning

confidence: 99%

Efficacy of Nitazoxanide against Clinical Isolates of Mycobacterium tuberculosis

Shigyo

Ocheretina

Merveille

et al. 2013

Antimicrob Agents Chemother

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“…Diarrhea caused by Giardia intestinalis and Entamoeba histolytica or Entamoeba dispar has also been shown to respond to NTZ (12,15). Furthermore, the drug was efficacious in a hamster model of antibiotic-induced diarrhea caused by Clostridium difficile compared to the standard vancomycin and metronidazole (MTZ) treatments (10).…”

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confidence: 99%

Nitazoxanide in Treatment of Helicobacterpylori : a Clinical and In VitroStudy

Guttner

Windsor

Viiala

et al. 2003

Antimicrob Agents Chemother

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Nitazoxanide (NTZ) is an antibiotic with microbiological characteristics similar to those of metronidazole but without an apparent problem of resistance. The aim of this study was the prospective evaluation of NTZ given as a single agent in the treatment of Helicobacter pylori infection. Twenty culture-positive patients with dyspepsia who had previously failed at least one course of H. pylori eradication therapy were enrolled. Subjects received 1 g of NTZ twice daily for 10 days. The safety and tolerability of the drug were assessed by physical examination, monitoring of adverse events, and clinical laboratory evaluation. Urea breath tests (UBTs) were performed 6 weeks posttreatment. H. pylori was isolated from UBT-positive patients by the string test or endoscopy with biopsy, and the MICs for these isolates were compared to those for isolates obtained pretherapy. The levels of tizoxanide, the active deacylated derivative of NTZ, were measured in blood, saliva, and tissue from two patients during treatment. The UBT results were positive for all 20 patients after completion of NTZ therapy. The MIC results demonstrated that the NTZ susceptibilities of none of the strains isolated from the patients posttherapy had changed significantly. No major adverse reactions were observed, but frequent minor side effects were observed. In conclusion, NTZ did not eradicate H. pylori when it was given as a single agent.Nitazoxanide (NTZ), a nitrothiazolyl-salicylamide compound first described by Rossignol and Cavier (J. F. Rossignol and R. Cavier, Chem. Abstr. 83:28216n, 1975), has a broad spectrum of activity against microaerobic and anaerobic bacteria, anaerobic protozoa, and helminths (1, 6). It is the first antiparasitic agent reported to be effective against both protozoa and helminths, particularly in the treatment of intestinal parasitic infections (8, 13). The pharmacokinetics and metabolism of NTZ have been studied after the administration of single oral doses to healthy subjects (18), as well as after administration of radiocarbon-labeled NTZ (4). The main circulating metabolites have been identified as deacetyl-NTZ or tizoxanide (TIZ) and the corresponding acyl-glucuronide.Previous studies showed that the incidence of adverse events was dose related, while vital signs, electrocardiograms, and laboratory test results remained unchanged (19). Side effects included loose stools, diarrhea, abdominal pain, flatulence, nausea, vomiting, dyspepsia, xerostomia, discolored urine (yellow-green), and headache (19,20).NTZ was the first effective treatment for cryptosporidial diarrhea in patients with AIDS, eradicating Cryptosporidium parvum from the intestinal tract (5,7,14,21), and has been successful in the treatment of microsporidiosis in a patient with AIDS (3). Diarrhea caused by Giardia intestinalis and Entamoeba histolytica or Entamoeba dispar has also been shown to respond to NTZ (12,15). Furthermore, the drug was efficacious in a hamster model of antibiotic-induced diarrhea caused by Clostridium difficile compared to the...

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“…Generally the recommended treatment for protozoa is by compounds as metronidazole, ornidazole and tinidzole [20] . Also multiple doses of albendazole or nitazoxanide can be used as alternative effective agent against intestinal protozoa [21][22][23] .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a deworming campaign by albendazole during 2016 in a rural area of Giza Governorate, Egypt

Dahesh

2018

Parasitologists United Journal

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Background: Egypt carried out the first national deworming campaign in 2016 targeting two million school-age children. The control program was led by the Endemic Diseases Department of the Egyptian Ministry of Health and Population (MOHP), in collaboration with the WHO Office in Egypt. Endemic Diseases Control Administration of Giza Governorate selected Tamwah village for the present work to represent the rural areas of Giza Governorate. The campaign targeted children from the first grade of primary schools aging around six years. In that campaign the children were treated with two doses of albendazole tablets 400 mg (two weeks apart). Objective: The present work aimed to evaluate the deworming campaign conducted during 2016 in one of the rural areas of Giza Governorate, Egypt and the efficacy of albendazole, the chosen treatment, in reducing parasitic infection rates among the targeted age group. The intention was to upgrade the results of the campaign by examining the same targeted group of children post treatment in comparison with a control group of untreated children from the same area thus widening the range of selected children. Also to collect environmental and epidemiological data for the study area of the examined children for constructing a new coordinative collaborative program suitable for controlling not only the soil transmitted parasites but also other endemic disease as schistosomiasis found in our study area. Subjects and methods: This cross-sectional study targeted two groups. The first group included all children of grade one in three primary schools who had received two doses of 400 mg albendazole tablets, two weeks apart. The second group (control group) included children of grade two who had not received medication. Stool specimens and anal swabs were collected from both treated and untreated control groups two weeks after receiving the second dose of treatment for the treated group. Personal and environmental data were recorded. The stool samples were examined by direct wet smear and kato-katz technique. The anal swabs were examined by saline swab method recommended for detection of Enterobius vermicularis ova. The data were tabulated and statistically analyzed. Results: E. vermicularis was the most prevalent parasite among the untreated group followed by E. histolytica/dispar, G. intestinalis and H. nana. Parasite rate of E. vermicularis among untreated females was twice that among males. The difference was statistically significant. Mass treatment with albendazole, resulted in significant differences between the parasite rates among the untreated and treated groups regarding E. vermicularis, E. histolytica/dispar and G. intestinalis. Treatment had no effect on parasite rate of H. nana. Generally the infection rates whether single or mixed, were significantly higher among untreated children than treated ones. Conclusion: The strategy of selecting albendazole for mass treatment in such areas proved appropriate, and suitably chosen since most of the prevalent parasites encountered ...

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Randomized clinical study of nitazoxanide compared to metronidazole in the treatment of symptomatic giardiasis in children from Northern Peru

Cited by 98 publications

References 29 publications

Efficacy of Nitazoxanide against Clinical Isolates of Mycobacterium tuberculosis

Efficacy of Nitazoxanide against Clinical Isolates of Mycobacterium tuberculosis

Nitazoxanide in Treatment of Helicobacterpylori : a Clinical and In VitroStudy

Evaluation of a deworming campaign by albendazole during 2016 in a rural area of Giza Governorate, Egypt

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