Efficacy of Nitazoxanide Compared to Ornidazole or Metronidazole as a Treatment for Intestinal Amebiasis among Egyptian Patients

Background: Entamoeba histolytica is considered the third leading cause of death from parasitic infections.
Objective: This study aimed to compare the efficacy of Metronidazole, Ornidazole, and Nitazoxanide in the treatment of intestinal amoebiasis.
Methods: 265 patients diagnosed with intestinal amebiasis by stool analysis were randomly assigned to one of three groups: Group 1 included 89 patients who received metronidazole 500 mg three times daily for 14 days, group 2 included 88 patients who received ornidazole 500 mg twice daily for 5 days, and group 3 included 88 patients who received nitazoxanide 500 mg once daily for 3 days. A total of 225 patients attended post-treatment follow-up visit and had stool analysis, and accordingly, have been included in the study. Extraintestinal amebiasis was ruled out before enrollment. Two stool samples were collected from each patient: One day pre-treatment: to confirm the diagnosis of intestinal amebiasis through the identification of E. histolytica trophozoites or cysts and one day post-treatment: to assess treatment efficacy. Eradication of E. histolytica infection after completion of treatment was the primary endpoint.
Results: Baseline characteristics were comparable between the three treatment groups. After treatment majority of all groups became negative after being positive with significant change (88% for group 1, 76% for group 2 and 84% for group 3) but without significant difference among groups (p = 0.19).
Conclusions: All three regimens demonstrated significant parasitological response rates; however, no significant difference in treatment efficacy was observed. Further large-scale, multicenter studies are warranted to confirm these findings.