Nitazoxanide-Based Therapy Shows Higher H. pylori Eradication Rates, Suggests Research
Pakistan: A study published in the Journal of Clinical Gastroenterology has reported that nitazoxanide-based regimens achieve higher Helicobacter pylori eradication rates compared with standard triple therapy.
Standard treatment consists of a 14-day course of a proton pump inhibitor, clarithromycin, and amoxicillin or metronidazole. However, clarithromycin resistance exceeding 15% in some regions has reduced the effectiveness of this regimen, highlighting the need for more effective alternative therapies such as nitazoxanide-based combinations.
Helicobacter pylori infection remains one of the leading causes of gastrointestinal disorders worldwide, contributing to chronic gastritis, peptic ulcer disease, and gastric malignancies. It is estimated to affect nearly half of the global population. The growing prevalence of antimicrobial resistance, particularly to clarithromycin and metronidazole, has significantly undermined the success of conventional eradication regimens. In this context, nitazoxanide (NTZ), a broad-spectrum antimicrobial agent with activity against various pathogens, has emerged as a potential alternative component in combination therapies targeting H. pylori.
To evaluate its comparative performance, Syed Hassan Ali, MBBS, from Liaquat University of Medical and Health Sciences, Jamshoro, Karachi, Sindh, Pakistan, and colleagues conducted an updated systematic review and meta-analysis of randomized controlled trials. The researchers performed a comprehensive search across four major databases and identified eight eligible trials involving a total of 1,286 participants. These studies directly compared NTZ-based triple regimens with the conventional clarithromycin-based triple therapy. A random-effects model was applied to calculate pooled risk ratios (RRs) with corresponding 95% confidence intervals (CIs).
The analysis revealed the following findings:
- NTZ-based therapy was associated with significantly higher H. pylori eradication rates compared to standard therapy.
- In the per-protocol analysis, NTZ regimens improved eradication outcomes with a pooled RR of 1.40.
- In the intention-to-treat analysis, NTZ-based therapy also showed superior eradication rates with an RR of 1.36.
- Follow-up assessments continued to favor NTZ-based therapy in the per-protocol population (RR=1.40).
- Follow-up results in the intention-to-treat population similarly supported NTZ therapy (RR=1.36).
- NTZ-based regimens showed a non-significant trend toward reduced abdominal pain (RR=0.50).
- A non-significant reduction in nausea was also observed with NTZ therapy (RR=0.78).
- The included trials demonstrated variable risk of bias, ranging from low to high.
- Despite this variation, the overall certainty of evidence was rated as high.
- Egger’s test indicated no significant publication bias, supporting the reliability of the findings.
The authors concluded that NTZ-based triple therapy appears to be a promising alternative to standard regimens in regions facing high clarithromycin resistance. They emphasized the need for further large-scale studies to determine the optimal duration of NTZ-based therapy, clarify resistance patterns, assess long-term safety, and evaluate its impact on symptom relief.
Reference:
Ali, Syed Hassan MBBS*; Shaikh, Umais Ahmed MBBS*; Shahzad, Alishba MBBS†; Khemani, Keertan MBBS†; Zeeshan, Vania MBBS†; Musharaf, Rabeya MBBS†; Kumar, Raam MBBS†; Raza, Fizza MBBS†; Hussain, Abeer Iftikhar MBBS†; Naeem, Umaimah MBBS†. Comparative Efficacy and Safety of Nitazoxanide-based Triple Therapy Versus Standard Triple Therapy in Treating Helicobacter Pylori Infections: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials. Journal of Clinical Gastroenterology ():10.1097/MCG.0000000000002328, January 15, 2026. | DOI: 10.1097/MCG.0000000000002328
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