Nitazoxanide for the Treatment of SIBO-Related Gastrointestinal Symptoms

Abstract

Purpose: Small intestinal bacterial overgrowth (SIBO) is a clinical condition defined as an abnormally high bacterial population in the small intestine. SIBO symptoms are variable, with abdominal pain or discomfort, bloating, diarrhea, and flatulence being the most common. Nitazoxanide (NTZ) is a first in class thiazolide antibiotic with a targeted anaerobic antibacterial activity, placebo-like safety profile, and high gastrointestinal (GI) concentration. To date no studies have evaluated the empiric use of NTZ for the treatment of GI related symptoms in SIBO patients. The purpose of this paper is to report on practice experience utilizing NTZ for the treatment of SIBO-related GI symptoms in a community setting. Methods: A chart review was performed on eleven consecutive patients treated with NTZ for the diagnosis of SIBO. The diagnosis of SIBO was made by the attending physician based on the patient's symptoms and positive lactulose breath test. Patients meeting this criteria were prescribed NTZ 500 mg twice daily for five days. Efficacy was measured as resolution of the patient's GI related symptoms 2–4 weeks after the end of therapy; repeat lactulose breath tests were not performed. The primary markers for resolution included: abdominal pain, diarrhea, bloating, and/or flatulence. Results: Of the eleven patients treated with NTZ, seven were available for follow-up evaluation. The four remaining patients have not returned to the clinic with any GI related complaints. A complete resolution of symptoms was reported in five out of the seven patients treated with NTZ. Of the two patients that did not respond to therapy, one patient was not able to tolerate the medication due to an unknown reason. The other nonresponder had failed multiple previous regimens including antibiotics, probiotics, and pancreatic enzymes. Table one summarizes patient responses to NTZ therapy.Table 1Conclusion: The empiric use of nitazoxanide 500 mg twice daily appears to be a safe and effective therapy for the treatment of SIBO-related GI symptoms. To further support these findings, larger controlled clinical trials are warranted.