Effect of nitazoxanide on diarrhea: A systematic review and network meta-analysis of randomized controlled trials

Hashan, Mohammad Rashidul; Elhusseiny, Khaled Mosaad; Huu-Hoai, Le; Tieu, Thuan Minh; Low, Soon Khai; Minh, Le Huu Nhat; Nghia, Thai Le Ba; Quang, Loc Le; Y, Mai Nhu; Eid, Peter Samuel; Abed, Mohammed; Elkolaly, Salma Said; Tawfik, Gehad Mohamed; Huy, Nguyen Tien

doi:10.1016/j.actatropica.2020.105603

Cited by 9 publications

(3 citation statements)

References 66 publications

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“…In the present study, Giardia infection in NHPs was not associated with clinical signs of diarrhea. These findings contrast with several studies on humans, in which 60–70% of infected persons show signs of diarrhea ( 39 ). Instead, the condition observed in the NHPs seems to be similar to the chronic asymptomatic carrier state that occurs in companion animals ( 40 – 43 ).…”

Section: Discussioncontrasting

confidence: 99%

Single and Synergistic Effects of Fenbendazole and Metronidazole Against Subclinical Infection by Giardia duodenalis in Non-Human Primates in a Zoological Garden in Southern Italy

et al. 2022

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The aim of this study was to assess the single and synergistic effects of fenbendazole (Fenb) and metronidazole (Metro) for the treatment of Giardia duodenalis infection in different species of non-human primates (NHPs) housed in a zoological garden of southern Italy. Moreover, the study also aimed to better define the circulation of G. duodenalis zoonotic assemblages in NHP and the potential occurrence of zoonotic transmission between the staff from the zoo and NHP. Briefly, six species that belonged to four families (Lemuridae, Cercopithecidae, Atelidae, and Hylobatidae) of NHP and housed in six cages (CG) were identified as Giardia positive and divided into two groups. Group F (N = 16 animals) was treated with Fenb (50 mg/kg, every 24 h for 5 consecutive days) and Group M (N = 7 animals) was treated with Metro (25 mg/kg, two times a day for 5 consecutive days). After the first round of therapy, all the animals were retreated for 5 days by inverting the drugs in each group. On each sampling day [study days (SDs) 3–24], the samples were tested for the presence of Giardia cysts using the FLOTAC technique. Multiple fecal tests for the antigen detection of Giardia, such as rapid ELISA and direct immunofluorescence (IFA), were performed at each sampling point only on samples that resulted in positive for Giardia cysts with FLOTAC. The efficacy of Fenb ranged from 30 to 67% and for Metro ranged from 82 to 96%. The results showed the synergistic effects of Metro and Fenb (98–100%) over the combination of Fenb and Metro (52–90%) against the infection by Giardia in NHPs. The overall k agreement between FLOTAC and IFA was reached 0.858 (p = 0.0001). In contrast, all the samples had a negative antigen result when using ELISA. At molecular analysis, six samples were confirmed positive for Giardia by nested PCR. Only two positive samples were successfully sequenced that showed 100% of identity with assemblage B. All the samples from the humans included in the study resulted in negative for Giardia cysts. Overall, the study emphasizes the need for regular monitoring of Giardia infections in NHP housed in zoos by traditional diagnostic tools combined with molecular characterization of the parasite.

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Section: Discussioncontrasting

confidence: 99%

Single and Synergistic Effects of Fenbendazole and Metronidazole Against Subclinical Infection by Giardia duodenalis in Non-Human Primates in a Zoological Garden in Southern Italy

et al. 2022

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“…At the time of this writing, nitazoxanide, is the only United States Food and Drug Administration (FDA) approved drug for the treatment of Cryptosporidium . It has activity against other protozoans as well such as Leishmaniasis, Giardiasis, and intestinal amebiasis [10] . Nitazoxanide has only been shown to improve the resolution of diarrhea, parasitological eradication, and improve mortality in HIV-seronegative patients, but not HIV-seropositive patients [11] .…”

Section: Discussionmentioning

confidence: 99%

Pneumatosis intestinalis caused by Cryptosporidium colitis in a non-immunocompromised patient

Tang

Akakulu

Desai

2022

IDCases

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Cryptosporidium is an obligate enteric protozoan parasite commonly associated with severe symptoms such as profound diarrhea and dehydration in the immunocompromised, particularly those living with HIV/AIDS. In the immunocompetent, Cryptosporidiosis is self-limited, and characterized by mild non-bloody diarrhea with associated nausea and vomiting. We present an unusual case of presumed Cryptosporidium colitis, in an immunocompetent host, characterized by anorexia and pneumoperitoneum.

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“…Infections with Giardia are treated with metronidazole in our setting, although treatment-refractory giardiasis is being reported [ 9 ]. In contrast, for Cryptosporidium no effective treatment is currently available, albeit that the use of nitazoxanide is suggested in some particular circumstances [ 10 ]. Diarrhoea is further managed by providing supportive treatment comprising oral rehydration solution (ORS), in combination with a 10–14 day supplemental treatment course of dispersible 20 mg zinc tablets, which shortens diarrhoea duration and improves outcomes [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Cryptosporidium and Giardia infections in under-five children with diarrhoea in Blantyre, Malawi

Bitilinyu-Bangoh,

Riesebosch,

Rebel

et al. 2024

BMC Infect Dis

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Background Diarrhoeal diseases are common among children in low- and middle-income countries and are major causes of morbidity and mortality. Cryptosporidium and Giardia are considered to be the main parasitic causes of diarrhoea in children. The aim of the present study was to determine the prevalence and associated factors of Cryptosporidium and Giardia infection in children under five years of age presenting at two health centres (Ndirande and Limbe) in Blantyre, Malawi. Methods This cross-sectional study was performed from February to July 2019 and included 972 children under 5 years of age with diarrhoea. Stool samples were immediately tested after collection at enrolment with a rapid diagnostic test for Cryptosporidium and Giardia infection. Descriptive statistics were used to assess the prevalence of these protozoan parasitic infections, and differences in the basic demographic and anthroponotic variables (between children with diarrhoea and parasite infection, being either Cryptosporidium and Giardia or both versus children with diarrhoea but no RDT confirmed parasite infection) were assessed. Their association with Cryptosporidium and Giardia infection was analysed using simple logistic regressions. Results Of the children recruited, 88 (9.1%) tested positive for Cryptosporidium and 184 (18.9%) for Giardia. Children with only a Giardia infection or a coinfection (of both parasites) were significantly older (mean age 24–26 months) compared to children with only a Cryptosporidium infection (mean age 13 months) or no parasitic infection (mean age 14 months). No significant differences were found with respect to gender, body temperature, stunting or wasting between the different groups of children with moderate to severe diarrhoea. Children attending the Ndirande health centre had almost two times higher odds of testing positive for both infections than those attending Limbe health centre. Conclusion Cryptosporidium and Giardia infections are highly prevalent in children < 5 years with moderate to severe diarrhoea attending the Limbe and Ndirande health centres in Blantyre, Malawi.

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Effect of nitazoxanide on diarrhea: A systematic review and network meta-analysis of randomized controlled trials

Cited by 9 publications

References 66 publications

Single and Synergistic Effects of Fenbendazole and Metronidazole Against Subclinical Infection by Giardia duodenalis in Non-Human Primates in a Zoological Garden in Southern Italy

Single and Synergistic Effects of Fenbendazole and Metronidazole Against Subclinical Infection by Giardia duodenalis in Non-Human Primates in a Zoological Garden in Southern Italy

Pneumatosis intestinalis caused by Cryptosporidium colitis in a non-immunocompromised patient

Prevalence of Cryptosporidium and Giardia infections in under-five children with diarrhoea in Blantyre, Malawi

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