Abstract
Australian Indigenous children suffer a high burden of diarrhoeal disease. Nitazoxanide is an antimicrobial that has been shown to be effective against a broad range of enteropathogens. To date, its use has not been reported in the tropical Top End (northernmost part) of the Northern Territory, Australia. The objective was to describe the use of nitazoxanide at the Royal Darwin Hospital, Northern Territory, and to assess any association with the time to resolution of diarrhoea. Eligible children (≤13 years) were identified from dispensary records as having been prescribed nitazoxanide during the audit period, 1 July 2007 to 31 March 2012. Patient demographics, symptoms, diarrheal aetiology, treatment details and clinical outcomes were obtained by chart review. Twenty-eight children were treated with nitazoxanide, mostly for Cryptosporidium infection associated with prolonged diarrhoea. Dehydration was evident in 27 (96%) children on admission, and 11 (41%) were underweight. Diarrhoeal duration prior to treatment was 11.5 days (6.5 days pre- and 5 days post-admission). For children ≥12 months, nitazoxanide was prescribed according to guidelines stipulated by the Centers for Disease Control and Prevention (CDC). Resolution of diarrhoea occurred a median of 2.4 days (IQR: 1.4-7.3) after starting treatment. An increase in weight for length at discharge was found for all children. Prompt resolution of diarrhoea without adverse outcomes suggests nitazoxanide may be an effective treatment for Cryptosporidium infection in this setting. Its role in the treatment of other causes of infectious diarrhoea needs further investigation. Randomised trials will further direct its use and determine optimal dosing regimens.
Highlights
Australian Indigenous children suffer a high burden of diarrhoeal disease
A total of 102 children were admitted with Cryptosporidium infection during the study period, but treatment only occurred in 26% of cases
Cryptosporidiosis is a notifiable disease. It is generally self-limiting in immunocompetent patients, recurrent symptoms develop in 40% of cases following initial resolution, and 45% develop persistent diarrhoea (>14 days)[22]
Summary
Australian Indigenous children suffer a high burden of diarrhoeal disease. Nitazoxanide is an antimicrobial that has been shown to be effective against a broad range of enteropathogens. The objective was to describe the use of nitazoxanide at the Royal Darwin Hospital, Northern Territory, and to assess any association with the time to resolution of diarrhoea. Results: Twenty-eight children were treated with nitazoxanide, mostly for Cryptosporidium infection associated with prolonged diarrhoea. Conclusions: Prompt resolution of diarrhoea without adverse outcomes suggests nitazoxanide may be an effective treatment for Cryptosporidium infection in this setting. It is the third leading cause of mortality in children less than 5 years, accounting for 800 000 deaths annually[1]. In the Northern Territory, Australia, Indigenous children are disproportionately burdened, with higher rates of hospitalisation and longer duration of illness than nonIndigenous children[2]. Prolonged and recurrent episodes of diarrhoeal illness can result in environmental enteropathy syndrome, and complications including severe dehydration, acidosis and hypokalaemia are more common[3]. Rehydration and correction of electrolyte imbalances are the mainstays of treatment, with an occasional role for targeted antimicrobial therapy
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