2643. Oral Nitazoxanide for Viral Gastroenteritis: A Single-Center Experience

BACKGROUND: Norovirus and serotypes (40/41) of adenoviruses are the leading cause of viral acute gastroenteritis in adults. The lack of therapeutic options can be devastating especially in the immunocompromised population. Nitazoxanide (NTZ), first designed as an antifolate anti-parasitic agent, is also known to have a broad-spectrum antiviral activity. Efficacy of NTZ in decreasing duration of symptomatic diarrhea in adults was first reported in a placebo controlled trial in 2006. Subsequent reports showed some promise as a possible therapeutic agent for viral gastroenteritis in the immunocompromised hosts. METHODS: Utilizing the inpatient pharmacy database we identified patients, who received NTZ for documented viral gastroenteritis, from January 1, 2008 to April 15, 2019. Chart review of cases was done to determine demographics, comorbidities, length of stay (LOS) in hospital, LOS in intensive care unit (ICU), duration of therapy, improvement in symptoms, and mortality. RESULTS: We identified 48 unique adult patients who were administered NTZ in the period under review. Of these 10 were prescribed NTZ specifically for viral gastroenteritis. 40% of the patients were females. The median age was 59 years (Interquartile Range [IR]: 47.75–69.25). Median LOS in hospital was 9.5 days (IR: 6.75–41.75). None of the patients required admission to the ICU. 4/10 patients had an active concomitant malignancy, of these 3 were receiving ongoing chemotherapy. 9/10 patients were recipients of stem cell (2) or solid-organ transplants (7). 7/10 patients were also on some form of immunosuppressive medications. Most common virus isolated was Norovirus (7/10). All patients received a standard dose of 500mg twice daily NTZ. The median duration of therapy was 7 days (range: 3–21). 6/10 patients had documented improvement in diarrhea at the end of treatment. 1/10 patients died within 30 days of diagnosis from causes unrelated to diarrheal illness (Table 1). CONCLUSION: Our limited data set presents interesting insights into treatment of viral gastroenteritis in immunocompromised hosts, in particular transplant recipients. All of the cases identified were treated in second half of study period after January 1, 2015, signaling an increasing interest in this therapy, especially in cases with prolonged symptoms or viral shedding. Our observations indicate a need for larger studies into this application of NTZ in adult immunocompromised hosts. [Image: see text] DISCLOSURES: All authors: No reported disclosures.