Nitazoxanide Based Therapeutic Regimens: Will this Solve the Puzzle of Increasing Resistance of Helicobacter pylori to Conventional Treatment?‎

A tiny, Gram-negative sprochete called Helicobacter pylori (H pylori) lives in the mucus layer that protects the stomach's epithelial cells in humans. A 50% of the world's population has this prevalent bacterial infection [8]. Additionally; it is the leading global cause of gastritis [3].  Additionally, H. pylori is a type 1 carcinogen and is the primary cause of stomach cancer, lymphoma, and mucus associated lymphatic tissue lymphoma (MALT), according to the World Health Organization [6].

The recommended treatment for H. pylori is the current traditional triple therapy, which includes proton pump inhibitors (PPI), amoxicillin, and clarithromycin. This is the accepted worldwide standard for treating H. pylori infection[3]. In instances of allergies or resistance, metronidazole  is used in place of amoxicillin or clarithromycin[11].However, a research by Gisbert et al. (2000) revealed that 30% of patients on intention to treat (ITT) and up to 50% of patients treated with a PPI-based triple therapy with metronidazole would fail treatment with a triple-based PPI treatment and first line therapy. [5]

This problem of treatment resistance calls for further research into alternative medications [10]. Due to emerging antibiotic resistance and poor patient compliance with finishing the treatment cycle, which lowers H. pylori elimination rates, H. pylori infection has grown extremely resistant to conventional first-line treatment regimens. As a result, there is a lot of interest in evaluating novel antibiotic combinations and therapy plans for H. pylori [4].‎

The antibiotic nitazoxanide (NTZ), which has been stabilised as a treatment, has microbiological properties that are comparable to those of metronidazole. It has a broad spectrum of action against microbial and anaerobic bacteria, anaerobic protozoa, and parasitic worms [1]. It is said to be helpful in treating parasitic infections of the intestines, particularly those caused by protozoa and parasitic worms [7],  and was investigated as an additional therapy for chronic hepatitis C virus along with pegylated Interferon and ribavirin. Additionally, it provided early proof that the drug was effective in treating chronic hepatitis B virus (HBV) after just one round of medication [2].

Inhibition of lipid polysaccharide (LS) caused by the production of pro-inflammatory cytokines in macrophages are additional noteworthy immune properties of nitazoxanide [9].

When NTZ and omeprazole were combined (1 g of NTZ twice daily with 20 milligrammes of omeprazole once daily) for seven days, 91 patients experienced an 83% eradication rate. Despite in vivo exposure during therapy and prolonged   in vitro exposure of H. pylori strains to NTZ, resistance could not be seen[2,7].