Rural treatment of COVID-19 patients with pirfenidone, nitazoxanide and colchicine. Case series

Submitted: November 5, 2021
Accepted: May 16, 2022
Published: June 8, 2022
Abstract Views: 1551
PDF: 444
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


Combined treatments against SARS-CoV-2 are emerging and some have taken into account the post-COVID-19 fibrosis. The aim of this survey was to report the experience of treating COVID-19 patients with pirfenidone, nitazoxanide (NTZ) and colchicine. It was a case series report of COVID-19 patients treated from December 2020 to March 2021, in a rural health center located in the State of Mexico, Mexico. 23 patients were included (mean age 44.5 ± 17.1 years), 12 women (mean age 45.9 ± 17.9 years) and 11 men (mean age 43 ± 16.9 years) with four deaths (17.39%). The evolution time was of 17.3 ± 6.7 days being the main symptoms fever (82.6%), myalgia (69.6%) and cough (65.2%). The main comorbidities were overweight/obesity 18 (78.26%), type 2 diabetes mellitus (T2DM) 4 (17.39%), Chronic obstructive pulmonary disease (COPD) 5 (21.73%) and systemic hypertension 2 (8.69%). Two patients were intubated and both died; in these cases, they refused to take NTZ until after three days the medical doctor had prescribed it for the first time. It can be concluded that implementing a mixed treatment with pirfenidone, NTZ and colchicine could improve the survival rate in ambulatory patients of low socioeconomic status.



PlumX Metrics


Download data is not yet available.


Graue Wiechers E. [The Social Service in medicine after 75 years of its establishment].[Article in Spanish]. Gac Med Mex 2012;148:276.
Mendieta Zerón H. [Cambios necesarios al Sistema de Salud en México].[Book in Spanish]. 1st ed. Hugo Mendieta Zerón; 2011.
Government of Mexico, Secretaría de Salud [Internet]. [240. Garantiza Secretaría de Salud becas de servicio social para pasantes de medicina y carreras afines].[in Spanish]. 2019. Available from:
Hamui-Sutton A. [Social conditions in which medical students from the faculty of medicine of the National University of Mexico (UNAM) perform their Social Service in rural areas]. Gac Med Mex 2012;148:277–80.
Editors, Gaceta Médica de México. [80 years of social service in medicine].[Article in Spanish]. Gac Med Mex 2016;152:581.
Nigenda G. [Social service in medicine in Mexico: an urgent and possible reform].[Article in Spanish]. Salud Publica Mex 2013;55:519-27. DOI:
Arredondo Trujillo F, Gascón Santos S, Espino Álvarez LA, Torres Morquecho M. [Agresiones hacia los médicos durante el servicio social].[Article in Spanish]. Gac Med Mex 2014;150:s331-7.
Imer Noticias [Internet]. [Inseguridad y precariedad: las dificultades para las y los pasantes de medicina].[Article in Spanish]. 2021. Available from:
Indigo [Internet]. [Medicina, profesión de alto riesgo, el caso de Luis Fernando Montes de Oca].[Article in Spanish]. 2016. Available from:
González Block MÁ, Reyes Morales H, et al. Mexico: Health system review. Health Syst Transit 2020;22:1–222.
Saludiario [Internet]. [El espeluznante Servicio Social: Si sobrevives te harán el favor de darte tu título].[Article in Spanish]. 2016. Available from:
El Universal [Internet]. [Inseguridad. Médicos pasantes: acorralados].[Article in Spanish]. 2018. Available from:
McDonald LT. Healing after COVID-19: are survivors at risk for pulmonary fibrosis? Am J Physiol Lung Cell Mol Physiol 2021;320:L257–65. DOI:
Upadhya P, Chary R, Chawla G, et al. New twist to an old problem: COVID-19 and idiopathic pulmonary fibrosis. Adv Respir Med 2021;89:84–5. DOI:
Lu Z-H, Yang C-L, Yang G-G, et al. Efficacy of the combination of modern medicine and traditional Chinese medicine in pulmonary fibrosis arising as a sequelae in convalescent COVID-19 patients: a randomized multicenter trial. Infect Dis Poverty 2021;10:31. DOI:
Zhang C, Jin H, Wen YF, Yin G. Efficacy of COVID-19 treatments: A Bayesian network meta-analysis of randomized controlled trials. Front Public Health 2021;9:729559. DOI:
Consejo de Salubridad General [Internet]. [Compendio Nacional de Insumos para la Salud Versión Digital, Informativa y Enunciativa].[ in Spanish]. Available from:
Meneses Calderón J, Figueroa Flores MDR, Paniagua Coria L, et al. Nitazoxanide against COVID-19 in three explorative scenarios. J Infect Dev Ctries 2020;14:982-6. DOI:
Sánchez Pérez IY. [Eficacia de colchicina como tratamiento en pacientes con diagnóstico confirmado de covid-19 sin ventilación mecánica invasiva en el servicio de medicina interna del Hospital General de Jilotepec, en un periodo que comprende del 1 de julio del 2020 al 30 de octubre del 2020]. Thesis in Spanish, UAEMéx. 2021. Available from:
Lancaster LH, de Andrade JA, Zibrak JD, et al. Pirfenidone safety and adverse event management in idiopathic pulmonary fibrosis. Eur Respir Rev 2017;26:170057. DOI:
Oishi K, Hirano T, Murata Y, et al. Medication persistence rates and predictive factors for discontinuation of antifibrotic agents in patients with idiopathic pulmonary fibrosis: a real-world observational study. Ther Adv Respir Dis 2019;13:1753466619872890. DOI:
Dhooria S, Agarwal R, Sehgal IS, et al. A real-world study of the dosing and tolerability of pirfenidone and its effect on survival in idiopathic pulmonary fibrosis. Sarcoidosis Vasc Diffuse Lung Dis 2020;37:148–57.
Hong SK, Kim HJ, Song CS, et al. Nitazoxanide suppresses IL-6 production in LPS-stimulated mouse macrophages and TG-injected mice. Int Immunopharmacol 2012;13:23-7. DOI:
Shou J, Kong X, Wang X, et al. Tizoxanide inhibits inflammation in LPS-activated RAW264.7 macrophages via the suppression of NF-κB and MAPK activation. Inflammation 2019;42:1336–49. DOI:
Cirillo P, Conte S, Pellegrino G, et al. Effects of colchicine on tissue factor in oxLDL-activated T-lymphocytes. J Thromb Thrombolysis 53:739-749. DOI:
Data Mexico [Internet]. [San Felipe del Progreso].[in Spanish] Available from:
Pearson L-A, Green CJ, Lin D, et al. Development of a high-throughput screening assay to identify inhibitors of the SARS-CoV-2 guanine-N7-methyltransferase using RapidFire mass spectrometry. SLAS Discov 2021;26:749–56. DOI:
Walker LE, FitzGerald R, Saunders G, et al. An open label, adaptive, phase 1 trial of high‐dose oral nitazoxanide in healthy volunteers: an antiviral candidate for SARS‐CoV‐2. Clin Pharmacol Ther 2022;111:585-94. DOI:
Mendieta Zerón H, Meneses Calderón J, Paniagua Coria L, et al. Nitazoxanide as an early treatment to reduce the intensity of COVID‑19 outbreaks among health personnel. World Acad Sci J 2021;3:23. DOI:
Lopes MI, Bonjorno LP, Giannini MC, et al. Beneficial effects of colchicine for moderate to severe COVID-19: a randomised, double-blinded, placebo-controlled clinical trial. RMD Open 2021;7:e001455. DOI:
Hendrickson KW, Peltan ID, Brown SM. The epidemiology of acute respiratory distress syndrome before and after coronavirus disease 2019. Crit Care Clin 2021;37:703-16. DOI:
Sweeney DA, Malhotra A. Coronavirus disease 2019 respiratory failure: what is the best supportive care for patients who require ICU admission? Curr Opin Crit Care 2021;27:462-7. DOI:
Rivera-Hernandez M, Ferdows NB, Kumar A. The impact of the COVID-19 epidemic on older adults in rural and urban areas in Mexico. J Gerontol B Psychol Sci Soc Sci 2021;76:e268-74. DOI:
Government of Mexico, Secretaría de Salud [Internet]. [Casos positivos y defunciones a COVID-19 por municipio].[in Spanish]. Available from:
Arriaga-Jordán CM, Pedraza-Fuentes AM, Velázquez-Beltrán LG, et al. Economic contribution of draught animals to Mazahua smallholder Campesino farming systems in the highlands of Central Mexico. Trop Anim Health Prod 2005;37:589-97. DOI:
Instituto de Salud del Estado de México. [Unidades Médicas].[in Spanish Available from:
Şimşek-Yavuz S, Komsuoğlu Çelikyurt FI. An update of anti-viral treatment of COVID-19. Turk J Med Sci 2021;51:3372-90. DOI:
Bazdyrev E, Rusina P, Panova M, et al. Lung fibrosis after COVID-19: Treatment prospects. Pharmaceuticals (Basel) 2021;14:807. DOI:
Li Y, Li H, Liu S, et al. Pirfenidone ameliorates lipopolysaccharide-induced pulmonary inflammation and fibrosis by blocking NLRP3 inflammasome activation. Mol Immunol 2018;99:134-44. DOI:
Firdaus H, Razak NA, Reza M, Khan NA, Shameem M. Clinical improvement with pirfenidone in two patients of COVID-19. J Clin Diagn Res 2020;14:14-16. DOI:
Momen ABI, Khan F, Saber S, et al. Usefulness of pirfenidone in Covid lung: A case series. Eur J Med Health Sci 2021;3:24–6. DOI:
Serra López-Matencio JM, Gómez M, Vicente-Rabaneda EF, et al. Pharmacological interactions of nintedanib and pirfenidone in patients with idiopathic pulmonary fibrosis in times of COVID-19 pandemic. Pharmaceuticals (Basel) 2021;14:819. DOI:
Shao Z, Feng Y, Zhong L, et al. Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID-19: a multicenter retrospective cohort study. Clin Transl Immunol 2020;9:e1192. DOI:
Rocco PRM, Silva PL, Cruz FF, et al. Early use of nitazoxanide in mild COVID-19 disease: randomised, placebo-controlled trial. Eur Respir J 2021;58:2003725. DOI:
Enríquez López KY, Meneses Calderón J, de la Cruz Ávila L, et al. Evolution of COVID-19 pregnancies treated with nitazoxanide in a third-level hospital. Cureus 2021;13:e15002. DOI:
Elalfy H, Besheer T, El‐Mesery A, et al. Effect of a combination of nitazoxanide, ribavirin, and ivermectin plus zinc supplement (MANS.NRIZ study) on the clearance of mild COVID‐19. J Med Virol 2021;93:3176-83. DOI:
Lien C-H, Lee M-D, Weng S-L, et al. Repurposing colchicine in treating patients with COVID-19: A systematic review and meta-analysis. Life 2021;11:864. DOI:
Hueda-Zavaleta M, Copaja-Corzo C, Bardales-Silva F, et al. [Factores asociados a la muerte por COVID-19 en pacientes admitidos en un hospital público en Tacna, Perú].[Article in Spanish]. Rev Peru Med Exp Salud Pública 2021;38:214-23. DOI:
Sattui SE, Crow MK, Navarro-Millán I. The role of immunomodulatory medications in the treatment of COVID-19. Curr Opin Rheumatol 2021;33:431–45. DOI:
Mikolajewska A, Fischer A-L, Piechotta V, et al. Colchicine for the treatment of COVID-19. Cochrane Haematology Group, editor. Cochrane Database Syst Rev 2021;10:CD015045. DOI:
Chérrez-Ojeda I, Vanegas E, Felix M. The unusual experience of managing a severe COVID-19 case at home: what can we do and where do we go? BMC Infect Dis 2020;20:862. DOI:
Lima-Morales R, Méndez-Hernández P, Flores YN, et al. Effectiveness of a multidrug therapy consisting of ivermectin, azithromycin, montelukast, and acetylsalicylic acid to prevent hospitalization and death among ambulatory COVID-19 cases in Tlaxcala, Mexico. Int J Infect Dis 2021;105:598-605. DOI:
Martínez-Guerra BA, de-León-Cividanes NA, Tamez-Torres KM, et al. Effect of tocilizumab in mortality among patients with severe and critical Covid-19: Experience in a third-level medical center. Rev Invest Clin 2022;74:40-50. DOI:
Kalil AC, Mehta AK, Patterson TF, et al. Efficacy of interferon beta-1a plus remdesivir compared with remdesivir alone in hospitalised adults with COVID-19: a double-bind, randomised, placebo-controlled, phase 3 trial. Lancet Respir Med 2021;9:1365-76. DOI:
Bestetti RB, Furlan-Daniel R, Silva VMR. Pharmacological treatment of patients with mild to moderate COVID-19: A comprehensive review. Int J Environ Res Public Health 2021;18:7212. DOI:

How to Cite

Iturbe Esquivel, Brandon, José Meneses Calderón, Luis Edgar Concepción Carrillo, and Hugo Mendieta Zeron. 2022. “Rural Treatment of COVID-19 Patients With Pirfenidone, Nitazoxanide and Colchicine. Case Series”. Monaldi Archives for Chest Disease 93 (1).