rifampin and nitazoxanide

In its 'Road map for neglected tropical diseases 2021-2030', the World Health Organization outlined its targets for control and elimination of neglected tropical diseases (NTDs) and research needed to achieve them. For many NTDs, this includes research for new treatment options for case management and/or preventive chemotherapy. Our review of small-molecule anti-infective drugs recently approved by a stringent regulatory authority (SRA) or in at least Phase 2 clinical development for regulatory approval showed that this pipeline cannot deliver all new treatments needed. WHO guidelines and country policies show that drugs may be recommended for control and elimination for NTDs for which they are not SRA approved (i.e. for 'off-label' use) if efficacy and safety data for the relevant NTD are considered sufficient by WHO and country authorities. Here, we are providing an overview of clinical research in the past 10 years evaluating the anti-infective efficacy of oral small-molecule drugs for NTD(s) for which they are neither SRA approved, nor included in current WHO strategies nor, considering the research sponsors, likely to be registered with a SRA for that NTD, if found to be effective and safe. No such research has been done for yaws, guinea worm, Trypanosoma brucei gambiense human African trypanosomiasis (HAT), rabies, trachoma, visceral leishmaniasis, mycetoma, T. b. rhodesiense HAT, echinococcosis, taeniasis/cysticercosis or scabies. Oral drugs evaluated include sparfloxacin and acedapsone for leprosy; rifampicin, rifapentin and moxifloxacin for onchocerciasis; imatinib and levamisole for loiasis; itraconazole, fluconazole, ketoconazole, posaconazole, ravuconazole and disulfiram for Chagas disease, doxycycline and rifampicin for lymphatic filariasis; arterolane, piperaquine, artesunate, artemether, lumefantrine and mefloquine for schistosomiasis; ivermectin, tribendimidine, pyrantel, oxantel and nitazoxanide for soil-transmitted helminths including strongyloidiasis; chloroquine, ivermectin, balapiravir, ribavirin, celgosivir, UV-4B, ivermectin and doxycycline for dengue; streptomycin, amoxicillin, clavulanate for Buruli ulcer; fluconazole and isavuconazonium for mycoses; clarithromycin and dapsone for cutaneous leishmaniasis; and tribendimidine, albendazole, mebendazole and nitazoxanide for foodborne trematodiasis. Additional paths to identification of new treatment options are needed. One promising path is exploitation of the worldwide experience wit

Topics: Anti-Infective Agents; Doxycycline; Drug Combinations; Fluconazole; Humans; Ivermectin; Neglected Diseases; Off-Label Use; Rifampin

Clostridium difficile disease is the major, known cause of nosocomial diarrhea and is an emerging cause of community-associated diarrhea. Recent outbreaks due to a strain of apparent increased virulence, BI/NAP1, and recognition of increasing metronidazole treatment failures as well as the morbidity associated with recurrent C. difficile disease have begun to spur studies to develop new therapies for C. difficile disease. Nitazoxanide, tolevamer, ramoplanin, and rifaximin are key agents being evaluated as new therapies for C. difficile disease. For now, vancomycin or metronidazole combined with discontinuation of antibiotics, when feasible, and expert infection control remain the mainstays of C. difficile disease management.

Topics: Animals; Anti-Bacterial Agents; Clostridioides difficile; Clostridium Infections; Community-Acquired Infections; Depsipeptides; Diarrhea; Humans; Nitro Compounds; Polymers; Rifampin; Sulfonic Acids; Thiazoles