Nitazoxanide for the Treatment Diverticulitis

Abstract

Purpose: In the United States, diverticulitis (DIV) is accountable for approximately 130,000 hospitalizations each year with a vast majority of these patients being over 50 years old. For less severe diverticular disease, a 7 to 10 day course of oral antibiotics with coverage against anaerobic organisms is often recommended. One of the more common antibiotic combinations used consists of a fluoroquinolone (FQ) and metronidazole (MTZ). While this combination is relatively efficacious, adverse drug reactions and the potential to induce Clostridium difficile disease is of considerable concern. Nitazoxanide (NTZ) is a first in class thiazolide antibiotic with excellent activity against anaerobic bacteria and an exceptional safety profile. Furthermore, NTZ has not been shown to induce Clostridium difficile disease and has a pharmacokinetic profile that is ideal for treating enteric diseases. This case series documents our practice experience utilizing NTZ for the treatment of DIV. To our knowledge, this is the first documentation of the use of NTZ in this manner. Methods: We report our experience with three DIV patients treated with oral NTZ 500 mg BID for 5 to 10 days. Each patient had previously been treated with a FQ and MTZ prior to the initiation of NTZ therapy with little to no improvement. Resolution of symptoms was documented upon return visit to our clinic. Results: Patient 1 –52 year old female with a history of recurrent DIV. In the past she had been treated with a combination of a FQ and MTZ with varying results. On this visit she had started her regular antibiotic regimen with mild improvement after 5 days. A course of NTZ 500 mg BID for 10 days was prescribed, at her follow-up visit 3 weeks later the patient was symptom free. Patient 2 –39 year old male with a history of at least three DIV flares in the previous 12 months, this was his fourth. The patient had started a FQ and MTZ regimen without resolution. At that time a 10 day course of NTZ 500 mg BID was given. The patient contacted our clinic reporting resolution of symptoms after completion of his course of NTZ. Patient 3 –52 year old male with a DIV flare. After 4 days of FQ and MTZ therapy the patient's symptoms had not resolved. He was then given a five day course of NTZ 500 mg BID which relieved him of his DIV symptoms. Conclusion: NTZ is a well-tolerated, potent agent against anaerobic bacteria with a pharmacokinetic profile well suited to treat DIV. A regimen of NTZ 500 mg BID for 5 to 10 days appears to be a safe and effective therapy for the treatment of DIV. Additional studies are warranted to validate the efficacy of NTZ in patients with DIV.