Use of nitazoxanide as a new therapeutic option for persistent diarrhea: a pediatric perspective

Despite advances in the management of diarrheal disorders, diarrhea is the second most frequent illness in the world. Persistent diarrhea, common in community pediatrics, is often caused by organisms such as Giardia lamblia, Cryptosporidium parvum and, less frequently, Cyclospora, Isospora belli, and Clostridium difficile. Identifying the causative organism is often challenging, and diagnostic tests may be inaccurate and expensive and, thus, of limited benefit. Consequently, carefully chosen empiric therapy guided by a physician's clinical impressions may be a useful and cost-effective option in children with persistent diarrhea, particularly those whose signs and symptoms suggest a protozoal etiology. This article discusses the empiric use of anti-infective nitazoxanide, a thiazolide compound, in three case reports of children with persistent diarrhea, and presents an overview of the diagnostic and therapeutic issues associated with this disorder and the pharmacodynamics and pharmacokinetics of the drug.