The Effectiveness of Oral Nitazoxanide Versus Oral Metronidazole in Pediatric Giardia lamblia-Induced Diarrhea
DOI:
https://doi.org/10.54112/bcsrj.v6i5.2233Keywords:
Giardia lamblia, diarrhea, pediatrics, nitazoxanide, metronidazole, effectivenessAbstract
Giardia lamblia is a common cause of diarrheal illness in children and contributes substantially to morbidity in low- and middle-income countries. Effective, well-tolerated, and short-course treatment options are important for improving clinical outcomes in pediatric patients. Objective: To compare the effectiveness of nitazoxanide versus oral metronidazole in pediatric Giardia lamblia-induced diarrhea at Khyber Teaching Hospital, Peshawar. Methods: This study was conducted on 340 children aged 1 to 15 years presenting with Giardia lamblia-induced diarrhea at the Department of Pediatrics, Khyber Teaching Hospital, Peshawar, from 14-August-2024 to 14-February-2025. Patients were allocated into two equal. Group A received oral nitazoxanide twice daily for three days. Group B received oral metronidazole twice daily for three days. Effectiveness was defined as resolution of diarrhea, with no abdominal cramps, bloating, or flatulence, and no unformed stools, three days after completing treatment. Data were analyzed using SPSS 23. The chi-square test was used to compare effectiveness between groups, with a p-value ≤ 0.05 considered statistically significant. Results: The study enrolled 340 children, 170 patients in group A (nitazoxanide) and group B (metronidazole). The mean age was 7.76±3.74 years in the nitazoxanide group and 8.68±4.18 years in the metronidazole group. Effectiveness was achieved in 145 (85.3%) patients receiving nitazoxanide compared to 123 (72.4%) patients receiving metronidazole. The difference was statistically significant (p = 0.003). Conclusion: Oral nitazoxanide was significantly more effective in pediatric giardia lamblia-induced diarrhea than oral metronidazole (85.3% versus 72.4%).
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References
1. Zaki ZDM. Prevalence of Entamoeba histolytica and Giardia lamblia associated with diarrhea in children referring to Ibn Al-Atheer Hospital in Mosul, Iraq. Arch Razi Inst. 2022;77(1):73-79.
2. Hooshyar H, Rostamkhani P, Arbabi M, Delavari M. Giardia lamblia infection: review of current diagnostic strategies. Gastroenterol Hepatol Bed Bench. 2019;12(1):3-12.
3. Thompson RCA. Giardiasis as a re-emerging infectious disease and its zoonotic potential. Int J Parasitol. 2000;30(12-13):1259-1267. DOI: https://doi.org/10.1016/S0020-7519(00)00127-2
4. Viesy S, Abdi J, Haghani K, Valizadeh R, Mirzaei A. Giardia lamblia subtypes and their relationship with clinical symptoms in patients with giardiasis. Infect Disord Drug Targets. 2020;20(3):396-400. DOI: https://doi.org/10.2174/1871526519666190314094437
5. Allain T, Buret AG. Pathogenesis and post-infectious complications in giardiasis. Adv Parasitol. 2020;107:173-199. DOI: https://doi.org/10.1016/bs.apar.2019.12.001
6. Al-Khikani FHO, Hameed RM, Ayit AS. Prevalence of Entamoeba histolytica and Giardia lamblia associated with infectious diarrhea in Al-Shomally population, Babil, Iraq. Biomed Biotechnol Res J. 2019;3(4):245-248. DOI: https://doi.org/10.4103/bbrj.bbrj_112_19
7. Kadir MA, El-Yassin ST, Ali AM. Detection of Entamoeba histolytica and Giardia lamblia in children with diarrhea in Tikrit city. Tikrit J Pure Sci. 2018;23(6):57-64. DOI: https://doi.org/10.25130/tjps.v23i6.672
8. Ortiz JJ, Ayoub A, Gargala G, Chegne NL, Favennec L. Randomized clinical study of nitazoxanide compared to metronidazole in the treatment of symptomatic giardiasis in children from northern Peru. Aliment Pharmacol Ther. 2001;15(9):1409-1415. DOI: https://doi.org/10.1046/j.1365-2036.2001.01066.x
9. Alshahethi MA, Edrees WH, Mogalli NM, Al-Halani AA, Al-Shehari WA, Reem A. Distribution and risk factors for Giardia lamblia among children at Amran Governorate, Yemen. Univ J Pharm Res. 2020;5(3). DOI: https://doi.org/10.22270/ujpr.v5i3.413
10. Ali AAE, Abdelrahim MEA, Elmoslamy NA, Said ASA, Meabed MH. Comparison between nitazoxanide and metronidazole in the treatment of protozoal diarrhea in children. Med Sci. 2014;3(2):1162-1173. DOI: https://doi.org/10.5455/medscience.2013.02.8117
11. Sami ul Haq, Mehmood A, Zahoor ul Haq, Ali S, Liaquat I, Hussain M. To compare the efficacy of 3 days treatment with nitazoxanide vs 5 days treatment with metronidazole in treating children with diarrhea caused by Giardia lamblia. Prof Med J. 2022;29(5):676-680. DOI: https://doi.org/10.29309/TPMJ/2022.29.05.6898
12. Irfan M, Najeeb S, Shah MKR, Sultan AN, Iftikhar N, Jamil MS. Evaluation of nitazoxanide versus metronidazole in pediatric Giardia lamblia-induced diarrhea: a comparative efficacy analysis. APMC. 2023;17(4):570-573. DOI: https://doi.org/10.29054/apmc/2023.1435
13. Miyamoto Y, Eckmann L. Drug development against the major diarrhea-causing parasites of the small intestine, Cryptosporidium and Giardia. Front Microbiol. 2015;6:1208. DOI: https://doi.org/10.3389/fmicb.2015.01208
14. López-Vélez R, Batlle C, Jiménez C, Navarro M, Norman F, Pérez-Molina J. Short course combination therapy for giardiasis after nitroimidazole failure. Am J Trop Med Hyg. 2010;83(1):171-173. DOI: https://doi.org/10.4269/ajtmh.2010.09-0742
15. Vakkilainen S, Nieminen T, Björkbacka S, Saavalainen-Hakala T, Salo E. Treatment of giardiasis in children: randomized trial of rectal metronidazole versus oral tinidazole. J Infect. 2020;81(5):816-846. DOI: https://doi.org/10.1016/j.jinf.2020.08.050
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Copyright (c) 2025 Saeed Ahmad, Zia Muhammad, Rehan Shahzad, Muhammad Zaid Hamid, Israr Hussain, Gul Khan
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