High dose prolonged treatment with nitazoxanide is not effective for cryptosporidiosis in HIV positive Zambian children: a randomised controlled trial.

Abstract

BACKGROUND:

Treatment of cryptosporidiosis in HIV infected children has proved difficult and unsatisfactory with no drugs having demonstrable efficacy in controlled trials except nitazoxanide. We hypothesised that a prolonged course of treatment with high dose nitazoxanide would be effective in treating cryptosporidiosis in HIV positive Zambian children.

METHODS:

We performed a double-blind, randomised, placebo controlled trial in paediatric patients in the UTH in Lusaka. The study included HIV positive children between one and eleven years of age if 2 out of 3 stool samples were positive for oocysts of Cryptosporidium spp. Children were given nitazoxanide suspension in a dose of 200 mg twice daily (bid) for 28 days (if 1-3 years old) or 400 mg bid for 28 days (if 4-11 years old), or matching placebo.

RESULTS:

Sixty children were randomised and 52 were fully evaluated. Only five children were 4 years of age or over and received the higher dose. In the primary efficacy analysis, 11 out of 26 (42%) in the active treatment group achieved a 'Well' clinical response compared to 8 out of 26 (35%) in the placebo group. Parasitological response was declared as 'Eradicated' in 27% in the active group and 35% in the placebo group. Mortality (16/52, 31%) did not differ by treatment allocation.

CONCLUSION:

We found no significant benefit in children with cryptosporidiosis despite high dose and longer treatment duration. This is the second randomised controlled trial to suggest that in Zambian children with HIV-related immunosuppression nitazoxanide does not eradicate this infection nor provide clinical symptom reduction.

TRIAL REGISTRATION:

The trial was registered as ISRCTN41089957.

• Authors: Beatrice Amadi, Mwiya Mwiya, Sandie Sianongo, Lara Payne, Angela Watuka, Max Katubulushi, Paul Kelly
• Journal: BMC infectious diseases (BMC Infect Dis) Vol. 9 Pg. 195 (Dec 02 2009) ISSN: 1471-2334 [Electronic] England
• PMID: 19954529 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Antiparasitic Agents
• Nitro Compounds
• Thiazoles
• nitazoxanide

Topics

• Antiparasitic Agents (therapeutic use)
• Child, Preschool
• Cryptosporidiosis (drug therapy)
• Double-Blind Method
• Female
• HIV Seropositivity (complications)
• Humans
• Infant
• Male
• Nitro Compounds
• Thiazoles (therapeutic use)
• Treatment Outcome
• Zambia