We aimed to systematically review evidence pertaining to the safety and efficacy of nitazoxanide in treating infectious diarrhea. On September 21, 2017, we identified relevant studies using 12 databases. The estimates of the included studies were pooled as a risk ratio (RR). We conducted a network and pairwise random-effects meta-analysis for both direct and indirect comparisons of different organisms that are known to cause diarrhea. The primary and secondary analysis outcomes were clinical response until cessation of illness, parasitological response and adverse events. We included 18 studies in our analysis. In cryptosporidiosis, the overall estimate favored nitazoxanide in its clinical response in comparison with placebo RR 1.46 [95% CI 1.22-1.74; P-value <0.0001]. Network meta-analysis among patients with Giardia intestinalis showed an increase in the probability of diarrheal cessation and parasitological responses in comparison with placebo, RR 1.69 [95% CI 1.08-2.64, P-score 0.27] and RR 2.91 [95% CI 1.72-4.91, P-score 0.55] respectively. In Clostridium difficile infection, the network meta-analysis revealed a non-significantly superior clinical response effect of nitazoxanide to metronidazole 31 days after treatment RR 1.21 [95% CI 0.87-1.69, P-score 0.26]. In Entamoeba histolytica, the overall estimate significantly favored nitazoxanide in parasitological response with placebo RR 1.80 [95% CI 1.35-2.40, P-value < 0.001]. We highlighted the effectiveness of nitazoxanide in the cessation of diarrhea caused by Cryptosporidium, Giardia intestinalis and Entamoeba histolytica infection. We also found significant superiority of NTZ to metronidazole in improving the clinical response to G. intestinalis, thus it may be a suitable candidate for treating infection-induced diarrhea. To prove the superiority of NTZ during a C. difficile infection may warrant a larger-scale clinical trial since its superiority was deemed insignificant. We recommend nitazoxanide as an appropriate option for treating infectious diarrhea.

我们旨在系统地审查有关硝唑尼特治疗感染性腹泻的安全性和有效性的证据。2017年9月21日，我们使用12个数据库确定了相关研究。纳入研究的估计数汇总为风险比（RR）。我们进行了网络和成对随机效应荟萃分析，以直接和间接比较已知引起腹泻的不同生物。主要和次要分析结果为直至疾病停止为止的临床反应，寄生虫学反应和不良事件。我们在分析中包括18个研究。在隐孢子虫病中，与安慰剂RR 1.46 [95％CI 1.22-1.74; P值<0.0001]。患者间的网络荟萃分析与安慰剂相比，肠道贾第鞭毛虫显示的止泻和寄生虫反应的可能性增加，RR为1.69 [95％CI 1.08-2.64，P评分为0.27]和RR 2.91 [95％CI 1.72-4.91，P评分为0.55]分别。在艰难梭菌感染中，网络荟萃分析显示，治疗后31天，硝唑尼奈特对甲硝唑的临床反应效果不明显（RR 1.21 [95％CI 0.87-1.69，P评分0.26]）。在溶组织性变形虫中，总体评估结果显着偏重于硝唑尼特安慰剂RR 1.80 [95％CI 1.35-2.40，P值<0.001]。我们强调了硝唑尼特在停止由隐孢子虫，贾第鞭毛虫引起的腹泻中的有效性和溶组织性变形杆菌感染。我们也提高到临床反应发现NTZ的显著优势甲硝唑G.肠，因此可用于治疗感染性腹泻的合适人选。要证明NTZ在艰难梭菌感染期间的优越性，可能需要进行大规模的临床试验，因为它的优越性被认为微不足道。我们建议硝唑尼特作为治疗感染性腹泻相应的选项。