McLeod C, Morris P S, Snelling T L, Carapetis J R, Bowen A C
Royal Darwin Hospital, Darwin, Northern Territory, Australia .
Menzies School of Health Research, Royal Darwin Hospital, Darwin, Northern Territory, Australia .
Rural Remote Health. 2014;14(2):2759. Epub 2014 Jun 12.
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.
澳大利亚原住民儿童腹泻病负担沉重。硝唑尼特是一种抗菌药物，已被证明对多种肠道病原体有效。迄今为止，在澳大利亚北领地热带顶端地区（最北部）尚未有其使用报告。目的是描述北领地达尔文皇家医院硝唑尼特的使用情况，并评估其与腹泻缓解时间的任何关联。
从药房记录中确定符合条件的儿童（≤13岁），这些儿童在审核期间（2007年7月1日至2012年3月31日）被开具了硝唑尼特。通过查阅病历获取患者人口统计学资料、症状、腹泻病因、治疗细节和临床结果。
28名儿童接受了硝唑尼特治疗，主要用于治疗与长期腹泻相关的隐孢子虫感染。27名（96%）儿童入院时存在脱水，11名（41%）体重不足。治疗前腹泻持续时间为11.5天（入院前6.5天，入院后5天）。对于≥12个月的儿童，根据美国疾病控制与预防中心（CDC）规定的指南开具硝唑尼特。开始治疗后，腹泻缓解的中位时间为2.4天（四分位间距：1.4 - 7.3天）。所有儿童出院时身长别体重均有所增加。
腹泻迅速缓解且无不良后果表明，在这种情况下硝唑尼特可能是治疗隐孢子虫感染的有效药物。其在治疗其他感染性腹泻病因中的作用需要进一步研究。随机试验将进一步指导其使用并确定最佳给药方案。
