Metronidazole/Nifuratel 841

African trypanosomiasis. Although there is no established al- Monensin (BAN, USAN, rINN) Nicarbazin (BAN) ternative treatment for Trypanosoma brucei rhodesiense infec- Lilly-67314; Monensina; Monensinum. 4-{2-[2-Ethyl-3′-methyl- Nicarbazina. An equimolecular complex of 1,3-bis(4-nitro- tions that are resistant to melarsoprol (see p.827), metronidazole 5′-(tetrahydro-6-hydroxy-6-hydroxymethyl-3,5-dimethylpyran- phenyl)urea (C13H10N4O5) and 4,6-dimethylpyrimidin-2-ol 1 and suramin were effective in 1 patient. 2-yl)perhydro-2,2′-bifuran-5-yl]-9-hydroxy-2,8-dimethyl-1,6-di- (C6H8N2O). 1. Foulkes JR. Metronidazole and suramin combination in the treat- oxaspiro[4.5]dec-7-yl}3-methoxy-2-methylpentanoic acid. Никарбазин ment of arsenical refractory rhodesian sleeping sickness—a case Монензин C H N O = 426.4. study. Trans R Soc Trop Med Hyg 1996; 90: 422. 19 18 6 6 C36H62O11 = 670.9. CAS — 330-95-0. Preparations CAS — 17090-79-8. ATC Vet — QP51AE03. ATC Vet — QP51AH03. BP 2008: Metronidazole Gel; Metronidazole Intravenous Infusion; Metron- idazole Oral Suspension; Metronidazole Suppositories; Metronidazole Tab- lets; NHO CH3 USP 31: Metronidazole Gel; Metronidazole Injection; Metronidazole Tab- CH3 CH H lets. 3 N Proprietary Preparations (details are given in Part 3) O O- O- Arg.: Bexon; Colpofilin; Dazotron; Epaq†; Etronil; Flagyl; Format; Ginkan; H H CH3 OO + CH3 + Gynotran; Metral; Metrocev; Metrolocal; Nalox; Noritate†; Padet; Repligen; HO H3C N N Rozex; Taremis; Tolbin; Tricofin; Trimstat†; Austral.: Flagyl; Metrogyl; Met- O H O O O ronide; Rozex; Austria: Acsacea; Anaerobex; Elyzol; Rozex; Trichex; Belg.: H O Anaeromet†; Flagyl; Pharmaflex†; Rosaced; Rozex; Braz.: Ambrosil†; Ame- H3C N N bil†; Astergyl†; Canderm; Dalzolston; Flagyl; Flanizol; Helmizol; Metrizol†; CH3 HO H H O CH3 Metrodax†; Metrogyl†; Metronib†; Metronide; Metroniflex; Metronil; Met- O HO ronin; Metronix; Metrotix†; Metroval; Metrozol; Minegyl†; Neo Metrodazol; H3C Profile Odonid; Rozex; Canad.: Flagyl; Florazole; Metrocream; Metrogel; Metrol- H3C OH Nicarbazin is an antiprotozoal used in veterinary practice for the otion; NidaGel; Noritate; Novo-Nidazol†; Trikacide; Chile: Deprocid; prevention of coccidiosis in poultry. Flagyl; Geloderm; Kabizol; Medazol; Metrocream; Metrogel; Metropast; Noritate†; Cz.: Deflamon†; Efloran; Entizol; Klion†; Medazol†; Rosalox; Ro- Pharmacopoeias. In US for veterinary use only. zex; Denm.: Elyzol; Flagyl; Metrogel†; Rozex; Zidoval; Fin.: Elyzol; Flagyl; USP 31 (Monensin). A mixture of antibiotic substances pro- Rosazol; Rozex; Trikozol; Zidoval; Fr.: Elyzol; Flagyl; Rosiced; Rozacreme; duced by Streptomyces cinnamonensis. Nifuratel (BAN, USAN, rINN) Rozagel; Rozex; Ger.: Arilin; Clont; Elyzol; Flagyl; Fossyol†; Infectoclont; Methylmercadone; Nifurateeli; Nifuratelum. 5-Methylthiomethyl- Metrocreme; Metrogel; Metronid-Puren†; Metronimerck; Metronour; Met- Monensin Sodium (BANM, rINNM) ront†; Rosiced; Vagimid; Gr.: Colpocin-T; Elyzol Dental; Emedal; Flagolin; 3-(5-nitrofurfurylideneamino)-2-oxazolidone. Monensin Sodique; Monensina sódica; Natrii Monensinum. Flagyl; Gnostol; Metrazol; Metrogyl; Periotret; Robaz; Rosiced; Trichovagil; Нифурател Tricodazole; Unitrim; Hong Kong: Elyzol; Flagyl; Gynoplix; Marphazole; Me- Натрий Монензин C10H11N3O5S = 285.3. tole; Metrogyl; Noritate; Qualigyl; Rozex; Unigo; Hung.: Klion; Rozex; Sup- C H NaO = 692.9. plin; India: Aristogyl; Flagyl; Giardyl†; Metrogyl; Monizole; Unimezol†; In- 36 61 11 CAS — 4936-47-4. CAS — 22373-78-0. don.: Anmerob; Biatron; Corsagyl; Dumozol; Farnat; Fladex; Flagyl; ATC — G01AX05. Flametia; Fortagyl; Metrofusin; Molazol; Nidazole; Promuba; Supplin; Tisma- Pharmacopoeias. In US for veterinary use only. ATC Vet — QG01AX05. zol; Trichodazol; Trogiar; Trogyl; Vagizol; Irl.: Anabact†; Flagyl; Metronide; USP 31 (Monensin Sodium). An off-white to tan crystalline Metrotop; Rozex; Israel: Elyzol; Flagyl; Metrogyl; Noritate; Rozex; Venogyl; powder. Slightly soluble in water; soluble in chloroform and in Zidoval; Ital.: Deflamon; Elyzol; Flagyl; Rosased†; Rozex; Vagilen; Zidoval; methyl alcohol; practically insoluble in petroleum spirit. Avoid O moisture and excessive heat. Malaysia: Flagyl; Frotin; Protogyl†; Ranigyl†; Rozex; Setrozole†; Mex.: O Ameblin; Antral†; Biomona; Biotazol; Dasmetrol; Dualizol; Elyzol; Epaq; Fag- Profile izol; Fartricon; Flagenase; Flagenol; Flagepat; Flagyl; Flamin†; Flaxtec; Fresen- O Monensin is an antiprotozoal used as the sodium salt in veteri- O2N N N SCH3 izol; Hemestal; Lagylan; Lamblit; Lozad; Medazol; Medizol; Messeldazol; Me- nary practice for the prevention of coccidiosis in poultry and as a tosan†; Metricom; Metrizol; Metrobendizol; Metrocream; Metrogel; growth promotor for cattle. Metroson; Milezzol; Nidralon-V; Nidrozol; Nitromidager; Ortrizol; Otrozol; Ovazol-V; Planizol; Promibasol; Prozolin; Retofar†; Samonil; Selegil†; Servi- Adverse Effects zol; Solumidazol; Stomffler; Valpar; Vanestrin-V; Vertisal; Neth.: Flagyl; Adverse effects associated with nifuratel include gastrointestinal Metrogel; Rosiced; Rozex; Norw.: Elyzol; Flagyl; Rozex; Zidoval; NZ: Flagyl; Narasin (BAN, USAN, rINN) disturbances, peripheral neuropathy, and thrombocytopenic pur- Rozex; Trichozole; Philipp.: Ameryl; Anerobia; Flagyl; Metrinox; Metrodal; pura. Allergic reactions, hepatotoxicity, blood dyscrasias, and Norstene; Patryl; Robaz; Rodazid; Servizol; Tricomycin; Triconex; Tridel; Compound 79891; Lilly-79891; Narasina; Narasine; Narasinum. 2-(6-{5-[2-(5-Ethyltetrahydro-5-hydroxy-6-methylpyran-2-yl)- pulmonary reactions similar to those seen with the structurally Vamogyl; Zol; Pol.: Metrosept; Rozex; Port.: Dumozol; Flagyl; Metro- related drug nitrofurantoin have been reported rarely. Haemolyt- 15-hydroxy-2,10,12-trimethyl-1,6,8-trioxadispiro[4.1.5.3]penta- derme; Norstene; Rodermil; Roseless; Rosiced; Rus.: Efloran (Эфлоран); ic anaemia may occur in patients with G6PD deficiency given Flagyl (Флагил); Klion (Клион); Metrogyl (Метрогил); Metroseptol dec-13-en-9-yl]-2-hydroxy-1,3-dimethyl-4-oxoheptyl}tetrahy- nifuratel. (Метросептол); Rosamet (Розамет); Trichopol (Трихопол); S.Afr.: Bem- dro-3,5-dimethylpyran-2-yl)butyric acid. etrazole; Flagyl; Medamet; Metagyl†; Metazol; Metrazole; Metrostat; Naro- Наразин Hypersensitivity. There have been several reports of contact bic; Rozex; Trichazole; Zagyl; Zobacide; Singapore: Fladex; Flagyl; Meda- dermatitis associated with nifuratel, including a report after only zole; Metrozole†; MND†; Nizole; Rozex; Spain: Amotein; Flagyl; Rozex; C43H72O11 = 765.0. one application of nifuratel ointment in a man whose wife was Tricowas B; Zidoval; Swed.: Elyzol†; Flagyl; Rozex; Zidoval; Switz.: Arilin; CAS — 55134-13-9. undergoing treatment with nifuratel vaginal pessaries.1 Elyzol; Flagyl; Metrolag; Perilox; Rivozol†; Rosalox; Rozex; Thai.: Asiazole; ATC Vet — QP51AH04. 1. Bedello PG, et al. Contact dermatitis from nifuratel. Contact Biogyl; Elyzol†; Flagyl; Med-Tricocide†; Medazyl†; Mefiron; Menisole; Dermatitis 1983; 9: 166. Mepagyl†; Mesolex†; Metrazole; Metrocide; Metrogyl; Metrolex; Metrovid; Milanidazole; Robaz; Tricomed; Unigo; Vagil†; Vagyl; Turk.: Flagyl; Metrajil; Precautions H3C Nifuratel should not be given to patients with renal impairment, Metrazol; Metrosel; Nidazol; Roza; UAE: Negazole; UK: Acea; Anabact; H C neuropathies, or G6PD deficiency. Elyzol; Flagyl; Metrogel; Metrolyl; Metrosa; Metrotop; Metrozol; Noritate; 3 Norzol; Rozex; Vaginyl; Zidoval; Zyomet; USA: Flagyl; Metrocream; Metro- CH3 Interactions gel; Metrogel Vaginal; Noritate; Protostat; Vandazole; Venez.: Bactrizol; Fle- O O A disulfiram-like reaction may occur in patients taking alcohol gyl; Menizol; Metren; Metris; Metrogyl; Metrovax; Rozek. while on nifuratel therapy. OH CH3 Multi-ingredient: Arg.: Bexon; Ciprocort; Estilomicin; Farm-X Duo; Pharmacokinetics Farm-X Ginecologico; Flagystatin; Ginal Cent; Ginkan; Linfol; Linfol Cicatri- HO O H C When taken orally nifuratel is absorbed from the gastrointestinal zante; Mailen; Monizol Cort; Naxo TV; Neocolpoben†; Ovumix; Pelvicillin H C 3 CH 3 O 3 tract. A metabolite, with activity against bacteria but not against NF; Pentol; Septigyn; Tratomax; Vagicural Plus; Austral.: Somac-MA; Aus- H C trichomonads, is excreted in the urine. tria: Helicocin; Braz.: Bio-Vagin; Colpatrin; Colpist; Colpistar; Colpistatin; HO 3 Donnagel; Flagyl Nistatina; Fungimax; Ginestatin; Minegyl C/Nistatina†; Ni- O OO Uses and Administration H C Nifuratel is a nitrofuran derivative with a broad antimicrobial stazol†; Periodontil; Profargil†; Tricolpex; Tricomax; Vagi Biotic; Vagimax; 3 HO CH3 Canad.: Flagystatin; Losec 1-2-3 M; Rosasol; Cz.: Klion-D; Rodogyl†; Fin.: spectrum. It is active against the protozoan Trichomonas vagina- Flagyl Comp; Helipak A; Helipak T; Losec Helira†; Fr.: Birodogyl; Missilor; lis and has an antibacterial spectrum similar to that of nitrofuran- Rodogyl; Tergynan; Hung.: Klion-D; India: Aristogyl Plus; Aristogyl-F; Baci- H3C toin and some antifungal activity against Candida albicans. Al- gyl-N†; Dyrade-M; Dysfur-M†; Entamizole; Flagyl-F†; Kaltin MF; Metrogyl-F†; though other drugs are preferred, nifuratel has been used to treat Neocip M; NM Powder; Okaflox M; Powergyl; Qugyl; Indon.: Fladystin; susceptible infections of the genito-urinary tract in oral doses of Pharmacopoeias. In US for veterinary use only. 200 to 400 mg three times daily. It has also been given vaginally. Flagystatin; Trichostatic; Vagistin; Ital.: Meclon; Malaysia: Neo-Penotran; USP 31 (Narasin Granular). It contains narasin mixed with suit- Rodogyl; Mex.: Acenil; Amebyl; Diodolina; Eskapar Compuesto; Flagenase able carriers and inactive ingredients prepared in a granular form Preparations 400; Flagocil; Flagystatin V; Gynotran; Lambliquin; Madecassol C; Metodine; that is free-flowing and free of aggregates. Narasin is a white to Proprietary Preparations (details are given in Part 3) Metrodiyod; Metrofur; Metroviform†; Norecil; Nysmosons-V; Promibasol- off-white crystalline powder. Soluble in water and in methyl al- Plus; Rodogyl; Stomffler Plus; Vagitrol-V; Philipp.: Flagystatin; Neo- Austria: Macmiror; Cz.: Macmiror; Ger.: Inimur; Hong Kong: Macmiror; cohol. Ital.: Macmiror; Mex.: Macmiror; Pol.: Macmiror; Rus.: Macmiror Penotran; Pol.: Gynalgin; Rus.: Gynalgin (Гиналгин); Klion-D (Клион-Д); (Макмирор). Metrogyl Denta (Метрогил Дента); Metrogyl Plus (Метрогил Плюс); Profile Neo-Penotran (Нео-Пенотран); Singapore: Flagystatin; Neo-Penotran; Narasin, an antibiotic produced by Streptomyces aureofaciens, is Multi-ingredient: Cz.: Macmiror Complex; Hong Kong: Macmiror Complex; Ital.: Macmiror Complex; Mex.: Macmiror Complex V; Pol.: Spain: Blastoestimulina; Rhodogil; Turk.: Neo-Penotran; Nidazol-M; UK: an antiprotozoal used in veterinary practice for the prevention of Macmiror Complex; Port.: Dafnegil; Rus.: Macmiror Complex (Макмирор HeliMet†; USA: Helidac; Pylera. coccidiosis in chickens. Комплекс).

The symbol † denotes a preparation no longer actively marketed The symbol ⊗ denotes a substance whose use may be restricted in certain sports (see p.vii) 842 Antiprotozoals

Nifursol (BAN, USAN, pINN) those who do not respond, with amphotericin B or pentamidine. Nimorazole may also be used in the treatment of acute ulcerative Nifursolum. 3,5-Dinitro-2′-(5-nitrofurfurylidene)salicylohydrazide. However, nifurtimox 10 mg/kg daily for a minimum of 4 weeks gingivitis in a dose of 500 mg twice daily for 2 days. has been shown to be effective in cases of mucocutaneous leish- Preparations Нифурсол maniasis in Colombia and Brazil. Despite this, toxic effects with C12H7N5O9 = 365.2. nifurtimox are common and its role as a second-line drug or with Proprietary Preparations (details are given in Part 3) CAS — 16915-70-1. pentavalent antimony has not been established.1 Arg.: Naxogin; Vagarne†; Austria: Naxogin; Belg.: Naxogin; Braz.: Nax- ATC Vet — QP51AX05. ogin; Chile: Naxogin†; Ger.: Esclama†; Rus.: Naxogin (Наксоджин). 1. WHO. Control of the leishmaniases. WHO Tech Rep Ser 793, Multi-ingredient: Arg.: Vagarne†; Braz.: Naxogin Composto; Chile: 1990. Naxogin Compositum; Naxogin Dos†; Indon.: Gynoxa; Naxogin Com- plex. H African trypanosomiasis. Nifurtimox has been tried as an al- N O ternative to melarsoprol or eflornithine in the meningoencepha- O N litic stage of Trypanosoma brucei gambiense infection (p.827), O2N but higher doses than those used in American trypanosomiasis OH are necessary. A good initial response was achieved1 in 25 pa- Nitazoxanide (BAN, USAN, rINN) tients with nifurtimox 15 mg/kg daily for 60 days, but 3 patients Nitazoxanida; Nitazoxanidum; PH-5776. N-(5-Nitro-2-thia- relapsed while still receiving nifurtimox and a further 12 of 19 zolyl)salicylamide acetate. O2N NO2 patients who were followed up relapsed subsequently. An attempt2 to improve the response by increasing the daily dose Нитазоксанид Profile even higher to 30 mg/kg for 30 days resulted in substantial tox- C12H9N3O5S = 307.3. icity and only a modest improvement in results, with 9 of 25 pa- CAS — 55981-09-4. Nifursol is an antiprotozoal used in veterinary practice for the 3 prevention of blackhead (histomoniasis) in poultry. tients relapsing. However, promising results have been reported ATC — P01AX11. from use of oral nifurtimox 15 mg/kg daily for 10 days with ef- lornithine 400 mg/kg daily intravenously for 7 days. 1. Pepin J, et al. An open clinical trial of nifurtimox for arseno- - resistant Trypanosoma brucei gambiense sleeping sickness in O (BAN, rINN) O Nifurtimox central Zaire. Trans R Soc Trop Med Hyg 1989; 83: 514–17. O N+ Bayer-2502; Nifurtimoxum. Tetrahydro-3-methyl-4-(5-nitrofur- 2. Pépin J, et al. High-dose nifurtimox for arseno-resistant Trypanosoma brucei gambiense sleeping sickness: an open trial S O O CH furylideneamino)-1,4-thiazine 1,1-dioxide. in central Zaire. Trans R Soc Trop Med Hyg 1992; 86: 254–6. 3 Нифуртимокс 3. Priotto G, et al. Nifurtimox-eflornithine combination therapy for second-stage Trypanosoma brucei gambiense sleeping sickness: C10H13N3O5S = 287.3. N N a randomized clinical trial in Congo. Clin Infect Dis 2007; 45: H CAS — 23256-30-6. 1435–42. ATC — P01CC01. ATC Vet — QP51AC01. American trypanosomiasis. The treatment of American trypanosomiasis (p.827) is generally unsatisfactory, but nifurti- mox is of value especially in the acute phase. However, there has been controversy over its ability to cure completely, that is to Adverse Effects CH 3 eradicate all parasites, in chronic disease.1 Doses recommended The most common adverse effects associated with ni- by WHO2,3 are 8 to 10 mg/kg daily in three divided doses for tazoxanide are abdominal pain and diarrhoea. Nausea O S N N adults, and 15 to 20 mg/kg daily in four divided doses for chil- and vomiting, flatulence, and increased appetite have O dren. WHO recommends that nifurtimox should be given for 60 also been reported. Headache may occur. Other report- or 90 days.2,3 Some in the USA4 suggest a 90- to 120-day regi- - men for adults but nifurtimox is not well tolerated and the expe- ed adverse effects include fever, malaise, pruritus, O + O N rience of other workers1 suggests that few patients may complete sweating, dizziness, and rhinitis. Discoloration of urine O the full course. and of the eyes has been reported rarely. Increased cre- 1. Gutteridge WE. Existing chemotherapy and its limitations. Br atinine and liver enzyme values have been noted. Med Bull 1985; 41: 162–8. Pharmacopoeias. In Fr. and Int. 2. WHO. Control of Chagas disease: second report of the WHO expert committee. WHO Tech Rep Ser 905 2002. Available at: Pharmacokinetics Adverse Effects http://libdoc.who.int/trs/WHO_TRS_905.pdf (accessed Nitazoxanide is absorbed from the gastrointestinal 17/07/08) Adverse effects are common with nifurtimox and in- 3. WHO. WHO model formulary. Geneva: WHO, 2004. tract after oral dosage and is rapidly hydrolysed to an clude gastrointestinal effects such as anorexia with loss 4. Abramowicz M, ed. Drugs for parasitic infections. 1st ed. New active desacetyl metabolite, tizoxanide. Tizoxanide of weight, abdominal pain, nausea and vomiting, and Rochelle NY: The Medical Letter, 2007. then partially undergoes conjugation, primarily by glu- effects on the nervous system, especially peripheral curonidation. The extent of absorption is enhanced if neuropathy. Psychoses, CNS excitement, insomnia, given with food and peak plasma concentrations of drowsiness, headache, myalgia, arthralgia, dizziness, Nimorazole (BAN, rINN) tizoxanide and the glucuronide are seen 1 to 4 hours and convulsions have also been reported. Skin rashes Nimorazol; Nimorazolum; Nitrimidazine. 4-[2-(5-Nitroimidazol- after an oral dose. The parent drug is not detected in and other allergic reactions may occur. 1-yl)ethyl]morpholine. plasma. Tizoxanide is more than 99% bound to plasma Ниморазол Mutagenicity. An increase in chromosomal aberrations has proteins. About two-thirds of an oral dose of nitazoxa- been seen in children given nifurtimox.1 C9H14N4O3 = 226.2. nide is eliminated in the faeces and one-third in the CAS — 6506-37-2. 1. Gorla NB, et al. Thirteenfold increase of chromosomal aberra- urine; tizoxanide is excreted in the urine, bile, and fae- tions non-randomly distributed in chagasic children treated with ATC — P01AB06. nifurtimox. Mutat Res 1989; 224: 263–7. ATC Vet — QP51AA06. ces, while the glucuronide is excreted in only the urine and bile. Pharmacokinetics Nifurtimox is well absorbed and rapidly metabolised N Uses and Administration after oral doses. Nitazoxanide is used for the treatment of cryptosporid- N iosis and giardiasis in immunocompetent patients. It is ◊ References. N 1. Paulas C, et al. Pharmacokinetics of a nitrofuran compound, ni- O2N given orally and should be taken with food. Doses are furtimox, in healthy volunteers. Int J Clin Pharmacol Ther Tox- O 100 mg twice daily for 3 days in those aged 1 to 3 icol 1989; 27: 454–7. 2. Gonzalez-Martin G, et al. The pharmacokinetics of nifurtimox in years, 200 mg twice daily for 3 days in those aged 4 to chronic renal failure. Eur J Clin Pharmacol 1992; 42: 671–3. Pharmacopoeias. In It. 11 years, and 500 mg twice daily for 3 days in adults. Adverse Effects and Precautions Nitazoxanide has also been tried in a number of other Uses and Administration As for Metronidazole, p.837. protozoal and helminth infections, particularly in im- Nifurtimox is a nitrofuran derivative with antiprotozo- munocompromised patients, including those with HIV al activity. It is of value in the treatment of American Pharmacokinetics Nimorazole is readily absorbed from the gastrointestinal tract. infection. It is also being investigated for the treatment trypanosomiasis (Chagas’ disease) due to infection by Peak blood concentrations are achieved within 2 hours, and high of rotavirus disease and Clostridium difficile colitis. Trypanosoma cruzi, especially the early acute stage of concentrations are reported to occur in salivary and vaginal se- ◊ Reviews. cretions. Trichomonicidal urinary concentrations may persist for the disease. In African trypanosomiasis it has some ac- 1. Bailey JM, Erramouspe J. Nitazoxanide treatment for giardiasis tivity against T. brucei gambiense, the organism re- up to 48 hours after a dose. It is excreted in the urine together and cryptosporidiosis in children. Ann Pharmacother 2004; 38: sponsible for West African sleeping sickness. with 2 active metabolites. Unchanged drug and metabolites also 634–40. appear in breast milk. 2. Fox LM, Saravolatz LD. Nitazoxanide: a new thiazolide antipar- Nifurtimox is given orally in 3 to 4 divided doses. It is Uses and Administration asitic agent. Clin Infect Dis 2005; 40: 1173–80. better tolerated by children than by adults. Treatment 3. Musher DM, et al. Nitazoxanide for the treatment of Clostridium Nimorazole is a 5-nitroimidazole derivative. It has antimicrobial difficile colitis. Clin Infect Dis 2006; 43: 421–7. for American trypanosomiasis is given for 60 to 120 actions and uses similar to those of metronidazole (p.839). 4. Anderson VR, Curran MP. Nitazoxanide: a review of its use in days (but see below). Doses for adults are 8 to In the treatment of trichomoniasis, the usual dose of nimorazole the treatment of gastrointestinal infections. Drugs 2007; 67: 10 mg/kg daily. Doses for children are: aged 1 to 10 is 2 g orally as a single dose with a main meal. It may alternative- 1947–67. years, 15 to 20 mg/kg daily for 90 days; aged 11 to 16 ly be given in a dose of 1 g every 12 hours for three doses, or Protozoal infections. As well as its established use in crypt- years, 12.5 to 15 mg/kg daily for 90 days. 250 mg three times daily for 5 to 7 days. In amoebiasis, nimora- osporidiosis (p.823) and giardiasis (p.824), nitazoxanide has zole 1 g is given twice daily, usually for 5 to 10 days and in gia- been used in other protozoal infections including intestinal Leishmaniasis. Mucocutaneous leishmaniasis of the New rdiasis a dose of 500 mg is given twice daily, usually for 5 to 7 amoebiasis (p.822), blastocytosis (p.823), and microsporidiosis World (p.824) is usually treated with pentavalent antimony or, in days. (p.826).