First use of nitazoxanide in Kelleni’s protocol for managing severe bronchiolitis in a 9-month-old infant - A case report and review of literature

Sep 28, 2026

Lower respiratory tract viral infections drive substantial child mortality, with infants under one year facing the highest risk, making safe and effective antiviral protocols urgent. This case describes a 9-month-old with severe bronchiolitis (high fever, tachypnea, wheezing, and oxygen desaturation) managed at home using Kelleni’s protocol, featuring age-adjusted nitazoxanide, ibuprofen, azithromycin, and immunomodulatory supportive agents. Clinical recovery occurred by day 14 without adverse events, with oxygen saturation normalizing by day 28.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Background

Case Summary

Conclusion

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Citation

| W | J | C | C | World Journal of
Clinical Cases | | --- | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Clin Cases 2025 December 26; 13(36): 113655 DOI: 10.12998/wjcc.v13.i36.113655 ISSN 2307-8960 (online) CASE REPORT First use of nitazoxanide in Kelleni’s protocol for managing severe bronchiolitis in a 9-month-old infant: A case report and review of literature Mina Thabet Kelleni Specialty type: Infectious diseases Provenance and peer review: Invited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade B, Grade B, Grade B, Grade B, Grade C Novelty: Grade A, Grade B, Grade B, Grade B, Grade B Creativity or Innovation: Grade A, Grade A, Grade B, Grade B, Grade B Scientific Significance: Grade A, Grade B, Grade B, Grade B, Grade C P-Reviewer: Rai S, MD, Professor, India; Soni P, MRCP, Lecturer, United Arab Emirates; Wang Y, Researcher, China Received: September 1, 2025 Revised: October 31, 2025 Accepted: December 15, 2025 Published online: December 26, 2025 Processing time: 116 Days and 18.8 Hours Mina Thabet Kelleni, Department of Medical Pharmacology, College of Medicine, Minia University, Minya 61519, Egypt Corresponding author: Mina Thabet Kelleni, MD, PhD, Assistant Professor, Department of Medical Pharmacology, College of Medicine, Minia University, Main Road Shalaby Land, Minya 61519, [Egypt.](Egypt. mina.kelleni@mu.edu.eg)[ mina.kelleni@mu.edu.eg](Egypt. mina.kelleni@mu.edu.eg) Abstract BACKGROUND Lower respiratory tract viral infections are a major cause of mortality in children under five years old, leading to hundreds of thousands of fatalities annually. The highest risk is observed in infants under one year old, underscoring the critical need for safe and effective antiviral protocols. CASE SUMMARY A 9-month-old infant suffered from severe bronchiolitis as manifested by high fever (39 °C), decreased appetite, tachypnea, wheezing, and oxygen desaturation (SpO2 84% on room air) and was effectively managed at home using Kelleni’s protocol, which includes age-adjusted dose of nitazoxanide (60 mg twice daily), ibuprofen and azithromycin, complemented by selective antihistaminic, antitussive and mucolytic immunomodulatory treatment. The fever resolved, wheezing became more prominent but without respiratory distress, and oxygen saturation gradually increased to 92% by day 10. Nitazoxanide exerts broad antiviral and immunomodulatory effects by enhancing host interferon responses and inhibiting viral replication, potentially attenuating airway inflammation and accelerating resolution of bronchiolitis. The nitazoxanide dose (60 mg twice daily for five days) was carefully adjusted based on the developmental expression and activity of the uridine diphosphate-glucuronosyltransferase 1A1 enzyme, responsible for its metabolism, ensuring safe age-appropriate administration. The infant’s clinical status steadily improved, and by day 14 the infant achieved full recovery with normalization of oxygen saturation (96% on room air) . No adverse events occurred, and follow-up at day 28 confirmed sustained recovery. CONCLUSION To the best of my knowledge, this report presents, for the first time globally, a potential of nitazoxanide within Kelleni’s protocol to early manage infants youn- WJCC [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 26, 2025 Volume 13 Issue 36 Kelleni MT. Nitazoxanide in severe infant bronchiolitis ger than one year suffering from severe lower respiratory tract viral infection at home. Selective antitussive treatment, using agents such as low dose benproperine, was employed to mitigate troublesome cough and improve patient comfort without compromising respiratory function. Additionally, alpha amylase was used to facilitate pulmonary secretion clearance. The protocol aims to reduce morbidity and mo

FAQs

What condition is addressed in the report, and who is the patient?

The report focuses on severe bronchiolitis caused by a lower respiratory tract viral infection in a 9-month-old infant.

How was Kelleni’s protocol used to manage the infant’s symptoms?

The protocol included age-adjusted nitazoxanide plus ibuprofen and azithromycin, along with selective antihistaminic, antitussive, mucolytic immunomodulatory treatments and supportive measures.

What were the clinical outcomes and whether were there adverse events?

Fever resolved and oxygen saturation improved progressively to 92% by day 10 and to 96% by full recovery. No adverse events occurred, and follow-up at day 28 confirmed sustained recovery.

Sep 28, 2026

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