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A recent discussion on the EIN listserv suggested the need for additional research into treatment options for norovirus in immunosuppressed patients with a protracted illness. Currently, there is no vaccine to prevent norovirus infection and no drug to treat people who are infected. (This webpage from the Centers for Disease and Control and Prevention (CDC)’s division of viral diseases offers additional information about noroviruses for the public and for clinicians.)
A member in Florida asked, “Has anyone had experience with immunosuppressed patients who have a prolonged illness with rotavirus or norovirus and used nitazoxanide?”
Putting the question in context, the member reported “seeing lots of gastroenteritis in my area among hospital staff, family and friends. One of our allogeneic BMT [bone-marrow transplant] patients admitted for dehydration and gastroenteritis tested positive for norovirus by PCR of stool.” The patient improved with hydration and time but was not on corticosteroids and was three years removed from his transplant. Another BMT patient experienced symptoms for a longer duration (two weeks) and “got much better with nitazoxanide 500mg po bid for one week, longer than the three-day usual course, which we instituted when the diagnosis was confirmed.”
The Florida member referenced three articles related to the use of nitazoxanide:
- An April 2009 article from Clinical Medicine: Therapeutics, “Current Approaches to the Treatment of Gastrointestinal Infections: Focus on Nitazoxanide.”
- An article from the November 2006 issue of Alimentary Pharmacology & Therapeutics, “Nitazoxanide in the treatment of viral gastroenteritis: a randomized double-blind placebo-controlled clinical trial.”
- An International Journal of Infectious Diseases article from July 2009, “Nitazoxanide vs. probiotics for the treatment of acute rotavirus diarrhea in children: a randomized, single-blind, controlled trial in Bolivian children.”
A respondent in Florida noted an article and related editorial that appeared in the October 2009 issue of Clinical Infectious Diseases and addressed allogeneic hematopoietic stem cell transplantation and norovirus gastroenteritis as a previously unrecognized cause of morbidity. “Nitazoxanide is not mentioned,” the respondent wrote.
A member in South Carolina asked if there had been “virologic confirmation of the etiology of the current apparently very widespread outbreak of a viral gastroenteritis syndrome in the last few weeks in the U.S.?”
The EIN member who posted the original question about nitazoxanide responded that a county health department on Florida’s Gulf Coast had reported outbreaks of norovirus in four chronic-care facilities and a nursing home. The member also referenced an October 2009 article in the New England Journal of Medicine about norovirus gastroenteritis. The article “never mentioned treatment with nitazoxanide, I assume because it’s a self-limited illness in the vast majority of people. Sounds like it’s a needed study in immunosuppressed patients with a protracted illness.”
More research may be needed in this area, as no EIN member was able to offer other suggestions for treatment of immunosuppressed individuals with prolonged illness.
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The Emerging Infections Network (EIN) is a provider-based sentinel network designed to help the public-health community detect trends in emerging infectious diseases.
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