Evaluation of nitazoxanide for the treatment of disseminated cystic echinococcosis: report of five cases and literature review.

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.

[1]  C. Franchi,et al.  Long-term evaluation of patients with hydatidosis treated with benzimidazole carbamates. , 1999, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  G. Gargala,et al.  Double‐blind, randomized, placebo‐controlled study of nitazoxanide in the treatment of fascioliasis in adults and children from northern Peru , 2003, Alimentary pharmacology & therapeutics.

[3]  M. Yasawy,et al.  Prospects in medical management of Echinococcus granulosus. , 2001, Hepato-gastroenterology.

[4]  N. Hajjaj-Hassouni,et al.  Hydatid disease of bone. Review of 11 cases. , 2003, Joint, bone, spine : revue du rhumatisme.

[5]  P. Torgerson,et al.  In vitro effects of nitazoxanide on Echinococcus granulosus protoscoleces and metacestodes. , 2004, The Journal of antimicrobial chemotherapy.

[6]  M. Zangeneh,et al.  The effect of combination therapy with albendazole and praziquantel on hydatid cyst treatment , 2008, Parasitology Research.

[7]  E. Keeffe,et al.  Clinical trial: randomized, double‐blind, placebo‐controlled study of nitazoxanide monotherapy for the treatment of patients with chronic hepatitis C genotype 4 , 2008, Alimentary pharmacology & therapeutics.

[8]  J. El-on.  Benzimidazole treatment of cystic echinococcosis. , 2003, Acta tropica.

[9]  T. Geary,et al.  In Vitro Parasiticidal Effect of Nitazoxanide against Echinococcus multilocularis Metacestodes , 2003, Antimicrobial Agents and Chemotherapy.

[10]  P. Leggat.  Tropical Infectious Diseases: Principles, Pathogens and Practice , 2011 .

[11]  H Maisonneuve,et al.  Nitazoxanide in the treatment of Taenia saginata and Hymenolepis nana infections. , 1984, The American journal of tropical medicine and hygiene.

[12]  M. Prabhakar,et al.  Spinal Hydatid Disease: A Case Series , 2005, The journal of spinal cord medicine.

[13]  WHO Informal Working Group.  International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. , 2003, Acta tropica.

[14]  E. Keeffe,et al.  Improved virologic response in chronic hepatitis C genotype 4 treated with nitazoxanide, peginterferon, and ribavirin. , 2009, Gastroenterology.

[15]  M. V. van Agtmael,et al.  Bone hydatid disease refractory to nitazoxanide treatment. , 2009, The American journal of tropical medicine and hygiene.

[16]  H. Gilles,et al.  Treatment of intestinal parasitic infections: a review of nitazoxanide. , 2002, Trends in parasitology.

[17]  R. Gilman,et al.  Evaluation of nitazoxanide and oxfendazole efficacy against cystic echinococcosis in naturally infected sheep. , 2009, The American journal of tropical medicine and hygiene.

[18]  M. Milićević,et al.  Changing concepts in the management of liver hydatid disease , 2005, Journal of Gastrointestinal Surgery.

[19]  M. Zwahlen,et al.  Treatment Response of Cystic Echinococcosis to Benzimidazoles: A Systematic Review , 2009, PLoS neglected tropical diseases.

[20]  D. Jenkins.  WHO/OIE manual on Echinococcosis in humans and animals: a public health problem of global concern ☆ , 2001 .

[21]  A. Fingerhut,et al.  Management of Cystic Echinococcosis Complications and Dissemination: Where is the Evidence? , 2009, World Journal of Surgery.

[22]  D. Harron,et al.  Pharmacokinetic interaction between praziquantel and albendazole in Sudanese men. , 1994, Annals of tropical medicine and parasitology.

[23]  W. Thormann,et al.  Secondary and primary murine alveolar echinococcosis: combined albendazole/nitazoxanide chemotherapy exhibits profound anti-parasitic activity. , 2004, International journal for parasitology.

[24]  J. Rossignol,et al.  Treatment of diarrhea caused by Giardia intestinalis and Entamoeba histolytica or E. dispar: a randomized, double-blind, placebo-controlled study of nitazoxanide. , 2001, The Journal of infectious diseases.

[25]  J. Rossignol,et al.  Treatment of diarrhea caused by Cryptosporidium parvum: a prospective randomized, double-blind, placebo-controlled study of Nitazoxanide. , 2001, The Journal of infectious diseases.

[26]  S. Reuter,et al.  In Vitro Activities of Itraconazole, Methiazole, and Nitazoxanide versus Echinococcus multilocularis Larvae , 2006, Antimicrobial Agents and Chemotherapy.

[27]  P. Chiodini,et al.  Clinical management of cystic echinococcosis: state of the art, problems, and perspectives. , 2008, The American journal of tropical medicine and hygiene.

[28]  M. Falagas,et al.  Albendazole for the Treatment of Human Echinococcosis: A Review of Comparative Clinical Trials , 2007, The American journal of the medical sciences.

[29]  J. McCarthy,et al.  Case report: nitazoxanide for treatment of refractory bony hydatid disease. , 2009, The American journal of tropical medicine and hygiene.

[30]  C. Yakut,et al.  Surgical treatment of cardiac hydatid disease in 13 patients. , 2010, Texas Heart Institute journal.

[31]  E. Brunetti,et al.  Update on cystic hydatid disease , 2009, Current opinion in infectious diseases.

[32]  J. Horton.  Albendazole for the treatment of echinococcosis. , 2003, Fundamental & clinical pharmacology.

[33]  M. Curran,et al.  Nitazoxanide , 2012, Drugs.

[34]  G. Sengul,et al.  Treatment of spinal hydatid disease: A single center experience , 2008, Journal of clinical neuroscience.

[35]  R. J. Horton.  Albendazole in treatment of human cystic echinococcosis: 12 years of experience. , 1997, Acta tropica.

[36]  Joachim Mueller,et al.  Nitazoxanide, a broad-spectrum thiazolide anti-infective agent for the treatment of gastrointestinal infections , 2006, Expert opinion on pharmacotherapy.

[37]  P. Chiodini,et al.  Praziquantel: neglected drug? Ineffective treatment? Or therapeutic choice in cystic hydatid disease? , 2009, Acta tropica.