A 14 Day Early Bactericidal Activity Study of Nitazoxanide for the Treatment of Tuberculosis

This is a prospective randomized two-arm 14-day, early bactericidal activity study in treatment-naive, drug-susceptible patients with uncomplicated pulmonary tuberculosis (TB). The study will be conducted at the GHESKIO Centers in Port au Prince Haiti. Twenty patients will be randomized to receive NTZ 1 gram orally twice daily for 14 days. Ten patients will be randomized as positive controls to receive standard 4 drug tuberculosis therapy with isoniazid (H), rifampin (R), ethambutol (E), and pyrazinamide (PZA). Patients' sputum will be collected before and then every two days during 14 days of treatment, and the primary endpoint will be the change in the number of M. tuberculosis in patients' sputum. Our primary hypothesis is that NTZ will result in a significant decrease in the number of M. tuberculosis in sputum during14 days of treatment. The number of M. tuberculosis will be quantified by the time to positive (TTP) signal in hours in an automated liquid media culture system (BACTEC MGIT 960, Becton Dickinson).

Inclusion criteria

• Men and women ages 18 - 65
• Diagnosed with pulmonary tuberculosis via: sputum-microscopy smear-positive (2+ or 3+) within 14 days plus Sputum GeneXpert positive within 14 days plus Chest radiograph consistent with M. tuberculosis within 14 days
• TB treatment naïve at time of enrollment
• Bodyweight > 40kg
• Negative HIV test within 30 days
• Able to complete activities of daily living (ADLs)
• All participants must agree not to participate in a conception process (i.e. active attempt to become pregnant or to impregnate, donate sperm, in vitro fertilization)
• All female participants must agree to use barrier methods such as condoms as well as hormonal contraception for dual prophylaxis.
• Able to give informed consent and demonstrate understanding of this study and willingness to participate in this study
• Willing to be hospitalized for 2 weeks

Exclusion criteria

• Pregnancy
• Evidence of complications of M. tuberculosis such as hemoptysis or shortness of breath
• Extrapulmonary manifestations of M. tuberculosis
• History of prior active tuberculosis
• Evidence of rifampin resistance via GeneXpert
• Previous diagnosis of diabetes or suggestion of impaired glucose metabolism via random plasma glucose
• Previous diagnosis of HIV by any rapid HIV test or by ELISA
• Any of the following lab abnormalities: Creatinine > 1.5 times the ULN; Random glucose > 2 times the ULN; ALT, AST, or alkaline phosphatase > 2 times the ULN; Hemoglobin < 7.5 g/dL
• Any participant currently taking antimycobacterial therapy or within the past 30 days
• Any concomitant illness that could compromise patient safety in this trial such as renal failure, chronic liver disease or alcoholic dependency
• Enrolled in another clinical trial