Activity of Nitazoxanide Against Viral Gastroenteritis: A Systematic Review

Introduction: Nitazoxanide is an oral anti-parasitic agent that has been found to have broad antiviral activity. Its role in the treatment of viral gastroenteritis is not well-studied. Given the worldwide prevalence of viral gastroenteritis, particularly in developing nations, a systematic review of this topic would be valuable. Methods: A formal literature search with the assistance of a reference librarian included randomized controlled trials, cohort studies, case-control studies, and case reports. Studies were included if they pertained to nitazoxanide use for viral gastroenteritis and excluded if nitazoxanide was used for parasitic or other viral illnesses. Results: Based on inclusion and exclusion criteria, 5 randomized controlled trials (2 in Egypt and 1 each in Peru, India, and Bolivia) were included in the systematic review. Four of the studies enrolled children only; one study included adults. All studies noted a statistically significant reduction in time from the first dose of nitazoxanide to resolution of illness (approximately one to 2 days) in patients compared to the receiving placebos (approximately 3 days). There were 9 case series or reports on nitazoxanide use for viral gastroenteritis in immunocompromised hosts; of these, only one case reported a noticeable effect of nitazoxanide in reducing symptom duration and severity. Conclusion: Despite the limited number of studies and the potential risk of bias introduced by the funding source, a benefit of nitazoxanide in reducing duration of illness from viral gastroenteritis was demonstrated for immunocompetent children. Randomized controlled trials are needed to elucidate the role of nitazoxanide for treating viral gastroenteritis in immunocompromised hosts.