Evaluation of Nitazoxanide versus Metronidazole in Pediatric Giardia lamblia-Induced Diarrhea: A Comparative Efficacy Analysis

Abstract

Background: The choice between shorter-duration Nitazoxanide and longer-duration Metronidazole regimens for treating Giardia lamblia-induced diarrhea in children requires careful consideration of efficacy, safety, and treatment adherence. Objective: The objective of this study is to compare the efficacy of a 3-day treatment regimen with Nitazoxanide to a 5-day treatment regimen with Metronidazole in children with diarrhea caused by Giardia lamblia. Study Design: Randomized controlled trial (RCT). Settings: Department of Paediatric, Shahida Islam Medical College, Lodhran Pakistan. Duration: From 1st September, 2022 to February 2023. Methods: Pediatric patients aged 1 to 12 years diagnosed with diarrhea attributed to Giardia lamblia infection. Exclusion criteria were children suffering from chronic gastrointestinal diseases, immunodeficiency disorders, or those who had undergone anti-parasitic medication in the last month. Subjects were randomised to one of two treatment groups in a random manner: Nitazoxanide Group: The patients were administered a 3-day regimen of Nitazoxanide at a dosage of 15 mg/kg/day, split into two separate doses. Metronidazole Group: Patients were administered a 5-day regimen of Metronidazole at a dosage of 30 mg/kg/day, which was divided into three equal doses. The primary outcome measure was the resolution of diarrhea, assessed by the absence of loose or watery stools for at least 24 hours. Statistical analysis was performed using SPSS to compare outcomes between the two treatment groups. Results: The mean age of patients in the Nitazoxanide group was 6.7 ± 2.3 years, while in the Metronidazole group, it was slightly lower at 6.3±2.1 years. In terms of gender distribution, there were 40 males (53.3%) and 35 females (46.7%) in the Nitazoxanide group, whereas in the Metronidazole group, there were 35 males (46.7%) and 40 females (53.3%). In the Nitazoxanide group, 90% of patients achieved resolution, with 68 patients. In contrast, 85% of patients in the Metronidazole group had resolved diarrhea, totaling 64 patients. Conclusion: In conclusion, our study found comparable efficacy between nitazoxanide and metronidazole for treating Giardia lamblia-induced diarrhea with 95% parasite clearance in nitazoxanide and 90% in metronidazole. However, nitazoxanide exhibits superior parasite clearance, suggesting its potential as a promising alternative in pediatric clinical practice.