Materiały źródłowe

• #1 Giardia infection (giardiasis) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giardia-infection/diagnosis-treatment/drc-20372790

  Children and adults who have giardia infection without symptoms usually don’t need treatment unless they’re likely to spread the parasites. […] When signs and symptoms are severe or the infection persists, doctors usually treat giardia infection with medications such as: […] Metronidazole is the most commonly used antibiotic for giardia infection. […] Tinidazole works as well as metronidazole and has many of the same side effects, but it can be given in a single dose. […] Nitazoxanide may be easier for children to swallow. […] There are no consistently recommended medications for giardia infection in pregnancy because of the potential for harmful drug effects to the fetus.

• #2 Giardiasis: What It Is, Symptoms, Treatments & Medications

  https://my.clevelandclinic.org/health/diseases/15238-giardiasis

  Giardiasis is a common illness caused by a parasite that may result in diarrhea and stomach cramps. Antibiotics can treat giardiasis. […] A healthcare provider can prescribe antiparasitic medications for giardiasis if you need them. […] Not everyone will need treatment for giardiasis. But if you have symptoms, your healthcare provider can prescribe antiparasitic medications to make the infection go away faster. With medications, most people feel better within a week. […] Antibiotics for giardiasis include: Metronidazole (Flagyl), Tinidazole (Tindamax), Nitazoxanide (Alinia), Paromomycin (Humatin). […] If your provider prescribes antibiotics, it’s important to take the full course to make sure the infection doesn’t rebound. […] If you continue to have symptoms for longer than six weeks, visit your healthcare provider. They can test you to find out if you’re still infected, or if your symptoms are due to the after-effects of the infection. They can offer treatment for either the infection itself or your symptoms and screen you for complications. […] If you’ve taken antibiotics but testing later finds you’re still infected, it’s possible that you need a different medication or combination.

• #3 Treatment of Giardia Infection | Giardia | CDC

  https://www.cdc.gov/giardia/treatment/index.html

  A healthcare provider can prescribe medicine to treat Giardia infections. […] You may not need medication to recover from a Giardia infection. […] Many prescription medications are available to treat Giardia infections. […] Therefore, it is important to discuss treatment options with a healthcare provider. […] If you do not have symptoms, you may not need medication for your Giardia infection. […] If you start having symptoms, even if they do not include diarrhea, talk with a healthcare provider to see if they recommend treatment. […] A healthcare provider may also recommend treatment if you live with a pregnant woman. […] If you have a weakened immune system (for example, due to illness such as HIV), your symptoms may last longer. Your healthcare provider can prescribe medications to help reduce the amount of time symptoms last.

• #4 Giardiasis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/giardiasis-treatment-and-prevention

  Giardiasis: Treatment and prevention […] Issues related to the treatment and prevention of giardiasis will be reviewed here. […] The goal of treatment in asymptomatic individuals is to prevent spread of infection to other, more vulnerable patient populations. We suggest treatment of asymptomatic individuals in the following circumstances (algorithm 1): Individuals in group settings with risk for transmission to others (such as a child in a daycare setting, health care workers, or nursing facility worker) […] Immunocompromised individuals.

• #5 Treatment of Giardia Infection | Giardia | CDC

  https://www.cdc.gov/giardia/treatment/index.html

  A healthcare provider can prescribe medicine to treat Giardia infections. […] You may not need medication to recover from a Giardia infection. […] Many prescription medications are available to treat Giardia infections. […] Therefore, it is important to discuss treatment options with a healthcare provider. […] If you do not have symptoms, you may not need medication for your Giardia infection. […] If you start having symptoms, even if they do not include diarrhea, talk with a healthcare provider to see if they recommend treatment. […] A healthcare provider may also recommend treatment if you live with a pregnant woman. […] If you have a weakened immune system (for example, due to illness such as HIV), your symptoms may last longer. Your healthcare provider can prescribe medications to help reduce the amount of time symptoms last.

• #6 Giardiasis Treatment & Management: Approach Considerations

  https://emedicine.medscape.com/article/176718-treatment

  In a systematic review and meta-analysis of seven trials comprising 639 patients to evaluate the efficacy of mebendazole in children with giardiasis, investigators found no clinical difference in parasitologic cure between mebendazole and metronidazole, with a relative risk of 0.81 but high heterogeneity. The researchers indicated clinicians should use caution in interpreting and using these results in clinical practice. […] Real-time polymerase chain reaction (PCR) may aid in the evaluation of treatment success. van den Bijllaardt et al showed it took about 1 week for samples to become negative after treatment of a G lamblia infection, indicating rapid clearance of the parasitic DNA following successful therapy. […] Treatment is indicated in any children with acute or chronic diarrhea who manifest a failure to thrive, malabsorption, or other gastrointestinal tract symptoms in whom the Giardia organisms have been identified. Generally, treatment is not needed for asymptomatic persons who excrete the organism, except to prevent household transmission (eg, from toddlers to pregnant women or to patients with hypogammaglobulinemia or cystic fibrosis) and to permit adequate treatment in individuals with possible Giardia intestinalis-associated antibiotic malabsorption who require oral antibiotic treatment for other infections.

• #7 Patient education: Giardia (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/giardia-beyond-the-basics/print

  Giardia treatment involves taking an antibiotic. The duration of treatment varies depending on the antibiotic given and on whether or not you have a weakened immune system. In most cases, this is enough to eliminate the infection and its symptoms. In stubborn cases that do not improve with the first round of antibiotics, doctors sometimes recommend changing the type, dose, or duration of treatment. […] If you do not have symptoms of Giardia but testing shows that you are infected, you may not need antibiotic treatment. However, children in daycare and people who handle food should be treated for Giardia even if they have no symptoms to prevent the spread of infection. […] Special considerations for children — Antibiotics are the most important part of Giardia treatment both in children and adults, but children sometimes need additional care. Diarrhea can cause dehydration and a salt imbalance, both of which can be especially tough on children. For them, drinks containing electrolytes may be recommended to restore what is lost through diarrhea.

• #8 Patient Care for Giardia Infection | Giardia | CDC

  https://www.cdc.gov/giardia/hcp/clinical-care/index.html

  Healthcare providers should consider a patient’s medical history, clinical signs, nutrition, and immune system status when treating Giardia infections. […] Multiple types of medications effectively treat Giardia infections. […] Several different types of medications can treat Giardia infections. However, some of these medications may not be readily available in the United States. […] Effective medications include: Tinidazole, Nitazoxanide, Metronidazole. […] Other medications healthcare providers can use to treat Giardia infection include: Albendazole, Mebendazole, Paromomycin, Quinacrine, Furazolidone. […] People treated for giardiasis may continue to have symptoms or positive tests for Giardia. […] If the patient tests positive, consider possible reinfection rather than treatment failure.

• #9 Treatment of Giardiasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC88965/

  Giardia lamblia is both the most common intestinal parasite in the United States and a frequent cause of diarrheal illness throughout the world. In spite of its recognition as an important human pathogen, there have been relatively few agents used in therapy. This paper discusses each class of drugs used in treatment, along with their mechanism of action, in vitro and clinical efficacy, and side effects and contraindications. Recommendations are made for the preferred treatment in different clinical situations. The greatest clinical experience is with the nitroimidazole drugs, i.e., metronidazole, tinidazole, and ornidazole, which are highly effective. A 5- to 7-day course of metronidazole can be expected to cure over 90% of individuals, and a single dose of tinidazole or ornidazole will cure a similar number.

• #10 Giardiasis Treatment & Management: Approach Considerations

  https://emedicine.medscape.com/article/176718-treatment

  Standard treatment for giardiasis consists of antibiotic therapy. Metronidazole (often 250 mg three times daily in adults for 5-7 days) is the most commonly prescribed antibiotic for this condition. However, metronidazole use has been associated with failure rates of up to 40% in clearing parasites from the gut as well as with poor patient compliance. More recently, the Infectious Diseases Society of America (IDSA) has recommended considerations for tinidazole (a single 2-g dose in adults, or 50 mg/kg up to a maximum of 2000 g in children 3 years), or nitazoxanide therapy (500 mg twice daily for 3 days in adults; age-based dosing in children 1 year old). […] However, an increasing incidence of nitroimidazole-refractory giardiasis has been reported, particularly in travelers from India and other regions in Asia. An optimal treatment strategy for refractory giardiasis remains to be determined, and no standard treatment regimen for nitroimidazole-refractory giardiasis exists yet. More recent evidence suggests that quinacrine regimens can be effective and could be considered in such nitroimidazole-refractory cases although this medication is not widely available in the United States, and it is not yet US Food and Drug Administration (FDA)-approved for giardiasis.

• #11 Giardiasis Medication: Antibiotics

  https://emedicine.medscape.com/article/176718-medication

  Antibiotic therapy is standard in the treatment of giardiasis. Antimicrobial resistance has been reported. […] Metronidazole is the antimicrobial agent most commonly used in the treatment of giardiasis in the United States (250 mg three times daily for 5-7 days). It has a cure rate of up to 85-90%, although resistance is becoming more prevalent. […] Tinidazole is also approved in the United States and considered a first-line agent outside the United States (a 2-g, one-time dose for adults). It is given in a single dose, the efficacy is reported at 90%, and it is believed to have fewer side effects than metronidazole. […] In cases of nitroimidazole-refractory giardiasis, combination therapy may need to be considered. […] Paromomycin has been recommended for use in pregnancy because systemic absorption is low (10 mg/kg three times daily for 5-10 days). This regimen may be effective, although it is not as efficacious as some alternative agents. […] Nitazoxanide can also be used, often dosed at 500 mg twice daily for 3 days in adults. […] Some treatments not available in the United States are considered effective therapeutic alternatives. Quinacrine achieves a cure rate of 90-95% but is not FDA approved or widely available.

• #12 Treatment of Giardiasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC88965/

  Patients who have resistant infection can usually be cured by a prolonged course of treatment with a combination of a nitroimidazole with quinacrine. […] The single-dose, short-course treatments (one high dose given daily) were designed to improve compliance without sacrificing efficacy. They have been used in both adults and children. […] The most common side effects of metronidazole treatment include headache, vertigo, nausea, and a metallic taste in the mouth. […] The recommended dosing for pediatric populations is usually 50 mg/kg for a single dose. […] The finding of therapeutic efficacy with metronidazole spurred investigators to develop and test other nitroimidazole derivatives. […] The other agents, tinidazole, ornidazole, and secnidazole, each have longer half-lives, making them suitable for single daily-dose therapies.

• #13 Giardiasis: Causes, Symptoms, and Treatment

  https://www.healthline.com/health/giardiasis

  Giardiasis is an infection in your small intestine. Its caused by a microscopic parasite called Giardia lamblia. […] In most cases, giardiasis eventually clears up on its own. Your doctor might prescribe medication if your infection is severe or prolonged. Most doctors will recommend treatment with antiparasitic drugs, rather than leaving it to clear up on its own. Certain antibiotics are commonly used to treat giardiasis: Metronidazole is an antibiotic that needs to be taken for five to seven days. It can cause nausea and leave a metallic taste in your mouth. […] Tinidazole is as effective as metronidazole, and often treats giardiasis in a single dose. […] Nitazoxanide is a popular option for children because its available in liquid form and only needs to be taken for three days. […] Paromomycin has a lower chance of causing birth defects than other antibiotics, although pregnant women should wait until after delivery before taking any medication for giardiasis. This medication is given in three doses over the course of 5 to 10 days.

• #14 Treatment of Giardiasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC88965/

  Patients who have resistant infection can usually be cured by a prolonged course of treatment with a combination of a nitroimidazole with quinacrine. […] The single-dose, short-course treatments (one high dose given daily) were designed to improve compliance without sacrificing efficacy. They have been used in both adults and children. […] The most common side effects of metronidazole treatment include headache, vertigo, nausea, and a metallic taste in the mouth. […] The recommended dosing for pediatric populations is usually 50 mg/kg for a single dose. […] The finding of therapeutic efficacy with metronidazole spurred investigators to develop and test other nitroimidazole derivatives. […] The other agents, tinidazole, ornidazole, and secnidazole, each have longer half-lives, making them suitable for single daily-dose therapies.

• #15 Giardiasis Medication: Antibiotics

  https://emedicine.medscape.com/article/176718-medication

  Antibiotic therapy is standard in the treatment of giardiasis. Antimicrobial resistance has been reported. […] Metronidazole is the antimicrobial agent most commonly used in the treatment of giardiasis in the United States (250 mg three times daily for 5-7 days). It has a cure rate of up to 85-90%, although resistance is becoming more prevalent. […] Tinidazole is also approved in the United States and considered a first-line agent outside the United States (a 2-g, one-time dose for adults). It is given in a single dose, the efficacy is reported at 90%, and it is believed to have fewer side effects than metronidazole. […] In cases of nitroimidazole-refractory giardiasis, combination therapy may need to be considered. […] Paromomycin has been recommended for use in pregnancy because systemic absorption is low (10 mg/kg three times daily for 5-10 days). This regimen may be effective, although it is not as efficacious as some alternative agents. […] Nitazoxanide can also be used, often dosed at 500 mg twice daily for 3 days in adults. […] Some treatments not available in the United States are considered effective therapeutic alternatives. Quinacrine achieves a cure rate of 90-95% but is not FDA approved or widely available.

• #16 Treatment of Giardiasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC88965/

  Adverse effects reported with tinidazole are not as common as with metronidazole but do include bitter taste, vertigo, and gastrointestinal upset. […] Secnidazole, a long-acting 5-nitroimidazole derivative, has been used but is not available in the United States. […] Quinacrine (Atabrine) was first introduced as an antimalarial agent in 1930, following the work of Kikuth, and became the antimalarial of choice for allied troops in World War II because of its greater availability and better tolerance compared with quinine. […] Furazolidone (Furoxone) is one of the thousands of nitrofuran compounds created since the class was discovered in the 1940s. […] Clinical studies using furazolidone are numerous and have been completed with a wide range of subjects, doses, and administration schedules.

• #17 Giardia infection (giardiasis) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giardia-infection/diagnosis-treatment/drc-20372790

  Children and adults who have giardia infection without symptoms usually don’t need treatment unless they’re likely to spread the parasites. […] When signs and symptoms are severe or the infection persists, doctors usually treat giardia infection with medications such as: […] Metronidazole is the most commonly used antibiotic for giardia infection. […] Tinidazole works as well as metronidazole and has many of the same side effects, but it can be given in a single dose. […] Nitazoxanide may be easier for children to swallow. […] There are no consistently recommended medications for giardia infection in pregnancy because of the potential for harmful drug effects to the fetus.

• #18 Treatment of Giardiasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC88965/

  Adverse effects reported with tinidazole are not as common as with metronidazole but do include bitter taste, vertigo, and gastrointestinal upset. […] Secnidazole, a long-acting 5-nitroimidazole derivative, has been used but is not available in the United States. […] Quinacrine (Atabrine) was first introduced as an antimalarial agent in 1930, following the work of Kikuth, and became the antimalarial of choice for allied troops in World War II because of its greater availability and better tolerance compared with quinine. […] Furazolidone (Furoxone) is one of the thousands of nitrofuran compounds created since the class was discovered in the 1940s. […] Clinical studies using furazolidone are numerous and have been completed with a wide range of subjects, doses, and administration schedules.

• #19 Giardiasis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/intestinal-protozoa-and-microsporidia/giardiasis

  Giardiasis is infection with the flagellated protozoan Giardia duodenalis (G. lamblia, G. intestinalis). […] Treatment is with oral metronidazole, tinidazole, secnidazole, or nitazoxanide. […] For symptomatic giardiasis, tinidazole, metronidazole, secnidazole, or nitazoxanide are used. Treatment failures and resistance can occur with any of them. […] Tinidazole is as effective as metronidazole, but tinidazole is taken in a single dose and metronidazole is taken for 5 to 7 days. […] Secnidazole is given orally as a single dose. […] Nitazoxanide is available in liquid form, which is useful for children, and as tablets. It is taken for 3 days. […] Furazolidone, quinacrine, or albendazole are rarely used because of potential toxicity, lower efficacy, or cost. […] Even after parasitologic cure, patients may experience lactose intolerance, irritable bowel syndrome, or fatigue that last for weeks to months. […] For symptomatic patients, use tinidazole, metronidazole, secnidazole, or nitazoxanide. […] Symptoms may persist after parasite clearance.

• #20 Treatment of Giardiasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC88965/

  Giardia lamblia is both the most common intestinal parasite in the United States and a frequent cause of diarrheal illness throughout the world. In spite of its recognition as an important human pathogen, there have been relatively few agents used in therapy. This paper discusses each class of drugs used in treatment, along with their mechanism of action, in vitro and clinical efficacy, and side effects and contraindications. Recommendations are made for the preferred treatment in different clinical situations. The greatest clinical experience is with the nitroimidazole drugs, i.e., metronidazole, tinidazole, and ornidazole, which are highly effective. A 5- to 7-day course of metronidazole can be expected to cure over 90% of individuals, and a single dose of tinidazole or ornidazole will cure a similar number.

• #21 Giardiasis – Wikipedia

  https://en.wikipedia.org/wiki/Giardiasis

  Treatment is not always necessary as the infection usually resolves on its own. However, if the illness is acute or symptoms persist and medications are needed to treat it, a nitroimidazole medication is used such as metronidazole, tinidazole, secnidazole or ornidazole. […] The World Health Organisation and Infectious Disease Society of America recommend metronidazole as first-line therapy. The US CDC lists metronidazole, tinidazole, and nitazoxanide as effective first-line therapies; of these three, only nitazoxanide and tinidazole are approved for the treatment of giardiasis by the US FDA. […] A meta-analysis published by the Cochrane Collaboration in 2012 found that compared to the standard of metronidazole, albendazole had equivalent efficacy while having fewer side effects, such as gastrointestinal or neurologic issues.

• #22 Patient Care for Giardia Infection | Giardia | CDC

  https://www.cdc.gov/giardia/hcp/clinical-care/index.html

  Healthcare providers should consider a patient’s medical history, clinical signs, nutrition, and immune system status when treating Giardia infections. […] Multiple types of medications effectively treat Giardia infections. […] Several different types of medications can treat Giardia infections. However, some of these medications may not be readily available in the United States. […] Effective medications include: Tinidazole, Nitazoxanide, Metronidazole. […] Other medications healthcare providers can use to treat Giardia infection include: Albendazole, Mebendazole, Paromomycin, Quinacrine, Furazolidone. […] People treated for giardiasis may continue to have symptoms or positive tests for Giardia. […] If the patient tests positive, consider possible reinfection rather than treatment failure.

• #23 Giardiasis Treatment & Management: Approach Considerations

  https://emedicine.medscape.com/article/176718-treatment

  Standard treatment for giardiasis consists of antibiotic therapy. Metronidazole (often 250 mg three times daily in adults for 5-7 days) is the most commonly prescribed antibiotic for this condition. However, metronidazole use has been associated with failure rates of up to 40% in clearing parasites from the gut as well as with poor patient compliance. More recently, the Infectious Diseases Society of America (IDSA) has recommended considerations for tinidazole (a single 2-g dose in adults, or 50 mg/kg up to a maximum of 2000 g in children 3 years), or nitazoxanide therapy (500 mg twice daily for 3 days in adults; age-based dosing in children 1 year old). […] However, an increasing incidence of nitroimidazole-refractory giardiasis has been reported, particularly in travelers from India and other regions in Asia. An optimal treatment strategy for refractory giardiasis remains to be determined, and no standard treatment regimen for nitroimidazole-refractory giardiasis exists yet. More recent evidence suggests that quinacrine regimens can be effective and could be considered in such nitroimidazole-refractory cases although this medication is not widely available in the United States, and it is not yet US Food and Drug Administration (FDA)-approved for giardiasis.

• #24 Giardia infection (giardiasis) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giardia-infection/diagnosis-treatment/drc-20372790

  Children and adults who have giardia infection without symptoms usually don’t need treatment unless they’re likely to spread the parasites. […] When signs and symptoms are severe or the infection persists, doctors usually treat giardia infection with medications such as: […] Metronidazole is the most commonly used antibiotic for giardia infection. […] Tinidazole works as well as metronidazole and has many of the same side effects, but it can be given in a single dose. […] Nitazoxanide may be easier for children to swallow. […] There are no consistently recommended medications for giardia infection in pregnancy because of the potential for harmful drug effects to the fetus.

• #25 Giardiasis: Causes, Symptoms, and Treatment

  https://www.healthline.com/health/giardiasis

  Giardiasis is an infection in your small intestine. Its caused by a microscopic parasite called Giardia lamblia. […] In most cases, giardiasis eventually clears up on its own. Your doctor might prescribe medication if your infection is severe or prolonged. Most doctors will recommend treatment with antiparasitic drugs, rather than leaving it to clear up on its own. Certain antibiotics are commonly used to treat giardiasis: Metronidazole is an antibiotic that needs to be taken for five to seven days. It can cause nausea and leave a metallic taste in your mouth. […] Tinidazole is as effective as metronidazole, and often treats giardiasis in a single dose. […] Nitazoxanide is a popular option for children because its available in liquid form and only needs to be taken for three days. […] Paromomycin has a lower chance of causing birth defects than other antibiotics, although pregnant women should wait until after delivery before taking any medication for giardiasis. This medication is given in three doses over the course of 5 to 10 days.

• #26 Patient Care for Giardia Infection | Giardia | CDC

  https://www.cdc.gov/giardia/hcp/clinical-care/index.html

  Healthcare providers should consider a patient’s medical history, clinical signs, nutrition, and immune system status when treating Giardia infections. […] Multiple types of medications effectively treat Giardia infections. […] Several different types of medications can treat Giardia infections. However, some of these medications may not be readily available in the United States. […] Effective medications include: Tinidazole, Nitazoxanide, Metronidazole. […] Other medications healthcare providers can use to treat Giardia infection include: Albendazole, Mebendazole, Paromomycin, Quinacrine, Furazolidone. […] People treated for giardiasis may continue to have symptoms or positive tests for Giardia. […] If the patient tests positive, consider possible reinfection rather than treatment failure.

• #27 Giardiasis – Wikipedia

  https://en.wikipedia.org/wiki/Giardiasis

  Treatment is not always necessary as the infection usually resolves on its own. However, if the illness is acute or symptoms persist and medications are needed to treat it, a nitroimidazole medication is used such as metronidazole, tinidazole, secnidazole or ornidazole. […] The World Health Organisation and Infectious Disease Society of America recommend metronidazole as first-line therapy. The US CDC lists metronidazole, tinidazole, and nitazoxanide as effective first-line therapies; of these three, only nitazoxanide and tinidazole are approved for the treatment of giardiasis by the US FDA. […] A meta-analysis published by the Cochrane Collaboration in 2012 found that compared to the standard of metronidazole, albendazole had equivalent efficacy while having fewer side effects, such as gastrointestinal or neurologic issues.

• #28 Drugs for treating giardiasis. – GOV.UK

  https://www.gov.uk/research-for-development-outputs/drugs-for-treating-giardiasis-192197

  Giardiasis infection may be asymptomatic, or can cause diarrhoea (sometimes severe), weight loss, malabsorption, and, in children, failure to thrive. It is usually treated with metronidazole given three times daily for five to 10 days. […] Albendazole may be of similar effectiveness to metronidazole, may have fewer side effects, and has the advantage of a simplified regimen. Large, high quality trials, assessing clinical outcomes (such as diarrhoea) will help assess further alternatives. […] We identified 19 trials involving 1817 participants, of which 1441 were children. Most trials had a small number of participants and were at high risk of bias. Albendazole is probably of similar effectiveness to metronidazole, probably has fewer side effects, and has the advantage of a simplified regimen. Large, high quality trials, assessing clinical outcomes are required to assess further alternatives.

• #29 Treatment of Giardiasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC88965/

  Treatment with mebendazole has resulted in widely divergent clinical results. […] The usual dosage in children is 15 mg/kg per day for 5 to 7 days. […] Paromomycin is generally considered safe because it is poorly absorbed from the intestine and excreted almost 100% unchanged in the feces. […] Bacitracin zinc was tested against Giardia in vitro and found to be active. […] The management of symptomatic G. lamblia infection during pregnancy is a challenge for the clinician because no therapeutic agent combines optimal efficacy and safety. […] An approach to the diagnosis and management of suspected giardiasis is illustrated in Fig. 2 and discussed in more detail above. If stools are negative, an empiric course of therapy can be given; however, an alternative diagnosis should be considered.

• #30 Giardiasis Treatment & Management: Approach Considerations

  https://emedicine.medscape.com/article/176718-treatment

  In a systematic review and meta-analysis of seven trials comprising 639 patients to evaluate the efficacy of mebendazole in children with giardiasis, investigators found no clinical difference in parasitologic cure between mebendazole and metronidazole, with a relative risk of 0.81 but high heterogeneity. The researchers indicated clinicians should use caution in interpreting and using these results in clinical practice. […] Real-time polymerase chain reaction (PCR) may aid in the evaluation of treatment success. van den Bijllaardt et al showed it took about 1 week for samples to become negative after treatment of a G lamblia infection, indicating rapid clearance of the parasitic DNA following successful therapy. […] Treatment is indicated in any children with acute or chronic diarrhea who manifest a failure to thrive, malabsorption, or other gastrointestinal tract symptoms in whom the Giardia organisms have been identified. Generally, treatment is not needed for asymptomatic persons who excrete the organism, except to prevent household transmission (eg, from toddlers to pregnant women or to patients with hypogammaglobulinemia or cystic fibrosis) and to permit adequate treatment in individuals with possible Giardia intestinalis-associated antibiotic malabsorption who require oral antibiotic treatment for other infections.

• #31 Diagnosis, Treatment and Prevention of Giardiasis | AAFP

  https://www.aafp.org/pubs/afp/issues/1998/0215/p802.html

  Several effective treatments are currently available for patients with symptomatic giardiasis. The majority of patients will respond to a five-day course of metronidazole. […] Tinidazole, given as a single dose, is widely used throughout the world but is not labeled for this use by the U.S. Food and Drug Administration. Furazolidone is currently the only drug labeled for the treatment of giardiasis in the United States and is often used to treat children. Albendazole seems to be comparable to metronidazole in efficacy and has fewer side effects. Paromomycin is a non-absorbable aminoglycoside that is not as effective as the other available agents but is commonly used for the treatment of giardiasis in pregnant women.

• #32 Giardiasis: What It Is, Symptoms, Treatments & Medications

  https://my.clevelandclinic.org/health/diseases/15238-giardiasis

  Giardiasis is a common illness caused by a parasite that may result in diarrhea and stomach cramps. Antibiotics can treat giardiasis. […] A healthcare provider can prescribe antiparasitic medications for giardiasis if you need them. […] Not everyone will need treatment for giardiasis. But if you have symptoms, your healthcare provider can prescribe antiparasitic medications to make the infection go away faster. With medications, most people feel better within a week. […] Antibiotics for giardiasis include: Metronidazole (Flagyl), Tinidazole (Tindamax), Nitazoxanide (Alinia), Paromomycin (Humatin). […] If your provider prescribes antibiotics, it’s important to take the full course to make sure the infection doesn’t rebound. […] If you continue to have symptoms for longer than six weeks, visit your healthcare provider. They can test you to find out if you’re still infected, or if your symptoms are due to the after-effects of the infection. They can offer treatment for either the infection itself or your symptoms and screen you for complications. […] If you’ve taken antibiotics but testing later finds you’re still infected, it’s possible that you need a different medication or combination.

• #33 Treatment of Giardiasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC88965/

  Treatment with mebendazole has resulted in widely divergent clinical results. […] The usual dosage in children is 15 mg/kg per day for 5 to 7 days. […] Paromomycin is generally considered safe because it is poorly absorbed from the intestine and excreted almost 100% unchanged in the feces. […] Bacitracin zinc was tested against Giardia in vitro and found to be active. […] The management of symptomatic G. lamblia infection during pregnancy is a challenge for the clinician because no therapeutic agent combines optimal efficacy and safety. […] An approach to the diagnosis and management of suspected giardiasis is illustrated in Fig. 2 and discussed in more detail above. If stools are negative, an empiric course of therapy can be given; however, an alternative diagnosis should be considered.

• #34 Giardiasis: Causes, Symptoms, and Treatment

  https://www.healthline.com/health/giardiasis

  Giardiasis is an infection in your small intestine. Its caused by a microscopic parasite called Giardia lamblia. […] In most cases, giardiasis eventually clears up on its own. Your doctor might prescribe medication if your infection is severe or prolonged. Most doctors will recommend treatment with antiparasitic drugs, rather than leaving it to clear up on its own. Certain antibiotics are commonly used to treat giardiasis: Metronidazole is an antibiotic that needs to be taken for five to seven days. It can cause nausea and leave a metallic taste in your mouth. […] Tinidazole is as effective as metronidazole, and often treats giardiasis in a single dose. […] Nitazoxanide is a popular option for children because its available in liquid form and only needs to be taken for three days. […] Paromomycin has a lower chance of causing birth defects than other antibiotics, although pregnant women should wait until after delivery before taking any medication for giardiasis. This medication is given in three doses over the course of 5 to 10 days.

• #35 Giardiasis Medication: Antibiotics

  https://emedicine.medscape.com/article/176718-medication

  Antibiotic therapy is standard in the treatment of giardiasis. Antimicrobial resistance has been reported. […] Metronidazole is the antimicrobial agent most commonly used in the treatment of giardiasis in the United States (250 mg three times daily for 5-7 days). It has a cure rate of up to 85-90%, although resistance is becoming more prevalent. […] Tinidazole is also approved in the United States and considered a first-line agent outside the United States (a 2-g, one-time dose for adults). It is given in a single dose, the efficacy is reported at 90%, and it is believed to have fewer side effects than metronidazole. […] In cases of nitroimidazole-refractory giardiasis, combination therapy may need to be considered. […] Paromomycin has been recommended for use in pregnancy because systemic absorption is low (10 mg/kg three times daily for 5-10 days). This regimen may be effective, although it is not as efficacious as some alternative agents. […] Nitazoxanide can also be used, often dosed at 500 mg twice daily for 3 days in adults. […] Some treatments not available in the United States are considered effective therapeutic alternatives. Quinacrine achieves a cure rate of 90-95% but is not FDA approved or widely available.

• #36 Treatment of Giardiasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC88965/

  Adverse effects reported with tinidazole are not as common as with metronidazole but do include bitter taste, vertigo, and gastrointestinal upset. […] Secnidazole, a long-acting 5-nitroimidazole derivative, has been used but is not available in the United States. […] Quinacrine (Atabrine) was first introduced as an antimalarial agent in 1930, following the work of Kikuth, and became the antimalarial of choice for allied troops in World War II because of its greater availability and better tolerance compared with quinine. […] Furazolidone (Furoxone) is one of the thousands of nitrofuran compounds created since the class was discovered in the 1940s. […] Clinical studies using furazolidone are numerous and have been completed with a wide range of subjects, doses, and administration schedules.

• #37 Patient Care for Giardia Infection | Giardia | CDC

  https://www.cdc.gov/giardia/hcp/clinical-care/index.html

  Healthcare providers should consider a patient’s medical history, clinical signs, nutrition, and immune system status when treating Giardia infections. […] Multiple types of medications effectively treat Giardia infections. […] Several different types of medications can treat Giardia infections. However, some of these medications may not be readily available in the United States. […] Effective medications include: Tinidazole, Nitazoxanide, Metronidazole. […] Other medications healthcare providers can use to treat Giardia infection include: Albendazole, Mebendazole, Paromomycin, Quinacrine, Furazolidone. […] People treated for giardiasis may continue to have symptoms or positive tests for Giardia. […] If the patient tests positive, consider possible reinfection rather than treatment failure.

• #38 Giardiasis Treatment & Management: Approach Considerations

  https://emedicine.medscape.com/article/176718-treatment

  Standard treatment for giardiasis consists of antibiotic therapy. Metronidazole (often 250 mg three times daily in adults for 5-7 days) is the most commonly prescribed antibiotic for this condition. However, metronidazole use has been associated with failure rates of up to 40% in clearing parasites from the gut as well as with poor patient compliance. More recently, the Infectious Diseases Society of America (IDSA) has recommended considerations for tinidazole (a single 2-g dose in adults, or 50 mg/kg up to a maximum of 2000 g in children 3 years), or nitazoxanide therapy (500 mg twice daily for 3 days in adults; age-based dosing in children 1 year old). […] However, an increasing incidence of nitroimidazole-refractory giardiasis has been reported, particularly in travelers from India and other regions in Asia. An optimal treatment strategy for refractory giardiasis remains to be determined, and no standard treatment regimen for nitroimidazole-refractory giardiasis exists yet. More recent evidence suggests that quinacrine regimens can be effective and could be considered in such nitroimidazole-refractory cases although this medication is not widely available in the United States, and it is not yet US Food and Drug Administration (FDA)-approved for giardiasis.

• #39 Giardiasis Medication: Antibiotics

  https://emedicine.medscape.com/article/176718-medication

  Antibiotic therapy is standard in the treatment of giardiasis. Antimicrobial resistance has been reported. […] Metronidazole is the antimicrobial agent most commonly used in the treatment of giardiasis in the United States (250 mg three times daily for 5-7 days). It has a cure rate of up to 85-90%, although resistance is becoming more prevalent. […] Tinidazole is also approved in the United States and considered a first-line agent outside the United States (a 2-g, one-time dose for adults). It is given in a single dose, the efficacy is reported at 90%, and it is believed to have fewer side effects than metronidazole. […] In cases of nitroimidazole-refractory giardiasis, combination therapy may need to be considered. […] Paromomycin has been recommended for use in pregnancy because systemic absorption is low (10 mg/kg three times daily for 5-10 days). This regimen may be effective, although it is not as efficacious as some alternative agents. […] Nitazoxanide can also be used, often dosed at 500 mg twice daily for 3 days in adults. […] Some treatments not available in the United States are considered effective therapeutic alternatives. Quinacrine achieves a cure rate of 90-95% but is not FDA approved or widely available.

• #40 Treatment of Giardiasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC88965/

  Adverse effects reported with tinidazole are not as common as with metronidazole but do include bitter taste, vertigo, and gastrointestinal upset. […] Secnidazole, a long-acting 5-nitroimidazole derivative, has been used but is not available in the United States. […] Quinacrine (Atabrine) was first introduced as an antimalarial agent in 1930, following the work of Kikuth, and became the antimalarial of choice for allied troops in World War II because of its greater availability and better tolerance compared with quinine. […] Furazolidone (Furoxone) is one of the thousands of nitrofuran compounds created since the class was discovered in the 1940s. […] Clinical studies using furazolidone are numerous and have been completed with a wide range of subjects, doses, and administration schedules.

• #41 Diagnosis, Treatment and Prevention of Giardiasis | AAFP

  https://www.aafp.org/pubs/afp/issues/1998/0215/p802.html

  Several effective treatments are currently available for patients with symptomatic giardiasis. The majority of patients will respond to a five-day course of metronidazole. […] Tinidazole, given as a single dose, is widely used throughout the world but is not labeled for this use by the U.S. Food and Drug Administration. Furazolidone is currently the only drug labeled for the treatment of giardiasis in the United States and is often used to treat children. Albendazole seems to be comparable to metronidazole in efficacy and has fewer side effects. Paromomycin is a non-absorbable aminoglycoside that is not as effective as the other available agents but is commonly used for the treatment of giardiasis in pregnant women.

• #42 Giardiasis – familydoctor.org

  https://familydoctor.org/condition/giardiasis/

  Giardiasis treatment […] If your symptoms are mild, you generally won’t need treatment for giardiasis. Mild infections can go away on their own in a few weeks. If symptoms are severe or aren’t going away, medicine can be used. Infected people who work at a daycare or nursing home may also be treated with medicine. This can help prevent the illness from spreading. […] There are many medicines that can be used to treat giardiasis. One of the most common is called metronidazole. It’s usually taken 3 times a day for 5 to 10 days. Side effects may include a metallic taste in the mouth, nausea, and a severe reaction to alcohol. It is safest for pregnant women to avoid this treatment. Children younger than 5 years of age may be treated with furazolidone. This medicine has fewer side effects and comes in a liquid form.

• #43 Patient Care for Giardia Infection | Giardia | CDC

  https://www.cdc.gov/giardia/hcp/clinical-care/index.html

  Consider inadequate dosing and duration of treatment. […] Consider combination therapy using medications from different classes if Giardia is confirmed by a positive stool test, you have ruled out reinfection and inadequate dosing, and the patient still has symptoms. […] If the patient’s stool samples still remain positive for Giardia even after combination therapy, consider an underlying immunodeficiency that may be preventing the patient from clearing the infection.

• #44 Treatment-refractory giardiasis: challenges and solutions | IDR

  https://www.dovepress.com/treatment-refractory-giardiasis-challenges-and-solutions-peer-reviewed-fulltext-article-IDR

  Regardless of the drug and the regimen used, a 100% parasitological cure rate is rarely achieved, implying that failure in clinical treatment of some giardiasis cases is to be considered. […] The possibility to test or confirm drug resistance in clinical isolates is strongly hampered by the well-documented difficulty to establish routine cultures. […] Treatment-refractory cases of giardiasis have been observed by clinicians for decades. […] Five decades of Giardia susceptibility to MTZ treatment is now replaced by increasing resistance, and the refractory giardiasis cases has also been reported after treatment with all other available drugs. […] The low success rate of monotherapy in treatment failure cases may be indicative of cross-resistance, as proved in vitro between MTZ and tinidazole, MTZ and ABZ, as well as between nitazoxanide and quinacrine.

• #45 Patient Care for Giardia Infection | Giardia | CDC

  https://www.cdc.gov/giardia/hcp/clinical-care/index.html

  Consider inadequate dosing and duration of treatment. […] Consider combination therapy using medications from different classes if Giardia is confirmed by a positive stool test, you have ruled out reinfection and inadequate dosing, and the patient still has symptoms. […] If the patient’s stool samples still remain positive for Giardia even after combination therapy, consider an underlying immunodeficiency that may be preventing the patient from clearing the infection.

• #46 Giardiasis Treatment & Management: Approach Considerations

  https://emedicine.medscape.com/article/176718-treatment

  Routine treatment of infected persons in highly endemic areas where water supplies continue to be contaminated is of questionable value because reinfection may readily occur. Treatment is indicated for all infected persons who live in nonendemic areas. […] If Giardia is found in the patient, a careful history should indicate whether this is a reinfection or a treatment failure. A second course of the same treatment, for a longer duration or a higher dose, should be effective in reinfections, whereas the use of an alternative drug should be used in true treatment failures. Quinacrine-based regimens may be considered if the medication is available. A combination therapy may be considered in certain cases of treatment failure. […] Patients who fail repeated courses of treatment should be evaluated for hypogammaglobulinemia and may require combination therapy or chronic suppressive therapy.

• #47 Patient education: Giardia (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/giardia-beyond-the-basics/print

  If your symptoms resolve after you finish your antibiotic treatment, you do not need to be tested for Giardia again. […] After being treated for Giardia and seeing symptoms improve, some people experience a relapse. This can happen because people are still infected with Giardia or because of changes in the intestine that cause heightened sensitivity to certain foods. […] If you or your child develop symptoms again after being treated for Giardia, your health care provider may want to run another stool test to determine if Giardia is causing the problem. If Giardia shows up again, it could be that the first round of treatment did not get all the organisms, or it could be that you or your child were reinfected somehow. Work with your health care provider to root out the possible source of the infection and ask about how you can prevent future infections.

• #48 Treatment of Giardiasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC88965/

  Patients who have resistant infection can usually be cured by a prolonged course of treatment with a combination of a nitroimidazole with quinacrine. […] The single-dose, short-course treatments (one high dose given daily) were designed to improve compliance without sacrificing efficacy. They have been used in both adults and children. […] The most common side effects of metronidazole treatment include headache, vertigo, nausea, and a metallic taste in the mouth. […] The recommended dosing for pediatric populations is usually 50 mg/kg for a single dose. […] The finding of therapeutic efficacy with metronidazole spurred investigators to develop and test other nitroimidazole derivatives. […] The other agents, tinidazole, ornidazole, and secnidazole, each have longer half-lives, making them suitable for single daily-dose therapies.

• #49

  https://journals.lww.com/co-infectiousdiseases/fulltext/2020/10000/giardiasis_treatment__an_update_with_a_focus_on.6.aspx

  Giardiasis remains a common cause of diarrhea and intestinal enteropathy globally. Here we give an overview of clinical treatment studies and discuss potential mechanisms and molecular targets for in-vitro testing of drug resistance. […] The prevalence of treatment refractory giardiasis is increasing. Recent studies reveal 5-nitroimidazole refractory infection occurs in up to 50% of cases. […] Based on the clinical studies reported, combination treatment with a 5-nitroimidazole and a benzimidazole is more effective than repeated courses of 5-nitroimidazole or monotherapies in refractory cases. […] A combination of a 5-nitroimidazole and albendazole or mebendazole, and quinacrine monotherapy, are rational choices in nitroimidazole refractory infections, but randomized controlled studies are needed.

• #50 Treatment-refractory giardiasis: challenges and solutions | IDR

  https://www.dovepress.com/treatment-refractory-giardiasis-challenges-and-solutions-peer-reviewed-fulltext-article-IDR

  An early study with six treatment-refractory cases, four of which had confirmed immunodeficiency, found a combination of quinacrine and MTZ to be effective in five of the cases, and the sixth case finally responded to a 3-week course of quinacrine and tinidazole. […] The increasing resistance toward the NIs is alarming as it prolongs the illness period and the treatment cost for giardiasis.

• #51

  https://journals.lww.com/co-infectiousdiseases/fulltext/2020/10000/giardiasis_treatment__an_update_with_a_focus_on.6.aspx

  The first-line treatment of giardiasis is the 5-nitroimidazoles, but there are reports of high incidence of nitroimidazole refractory cases of giardiasis. […] Drug trials have usually shown efficacy above 90% for the nitroimidazoles; however, treatment refractory disease is an increasing problem. […] Quinacrine is effective in almost all cases, but due to availability problems and potentially severe side effects, the drug is normally preferred only when other treatment options fail. […] Combination of drugs from different classes also seems to be an effective second-line option. […] Nitroimidazole failure in up to 50% is reported in giardiasis, both among travelers and in high endemic countries. Repeated courses of nitroimidazole, and monotherapy with a drug with another mode of action, seem to be less effective than combination therapy.

• #52 Treatment of Giardiasis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC88965/

  Treatment with mebendazole has resulted in widely divergent clinical results. […] The usual dosage in children is 15 mg/kg per day for 5 to 7 days. […] Paromomycin is generally considered safe because it is poorly absorbed from the intestine and excreted almost 100% unchanged in the feces. […] Bacitracin zinc was tested against Giardia in vitro and found to be active. […] The management of symptomatic G. lamblia infection during pregnancy is a challenge for the clinician because no therapeutic agent combines optimal efficacy and safety. […] An approach to the diagnosis and management of suspected giardiasis is illustrated in Fig. 2 and discussed in more detail above. If stools are negative, an empiric course of therapy can be given; however, an alternative diagnosis should be considered.

• #53 Giardia infection (giardiasis) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giardia-infection/diagnosis-treatment/drc-20372790

• #54 Giardiasis – Wikipedia

  https://en.wikipedia.org/wiki/Giardiasis

  While tinidazole has side effects and efficacy similar to those of metronidazole, it is administered with a single dose. […] Resistance has been seen clinically to both nitroimidazoles and albendazole, but not nitazoxanide, though nitazoxanide resistance has been induced in research laboratories. […] In the case of nitroimidazole-resistant strains of Giardia, other drugs are available which have shown efficacy in treatment including quinacrine, nitazoxanide, bacitracin zinc, furazolidone and paromomycin. […] Probiotics, when given in combination with the standard treatment, have been shown to assist with clearance of Giardia. […] During pregnancy, paromomycin is the preferred treatment drug because of its poor intestinal absorption, resulting in less exposure to the foetus. Alternatively, metronidazole can be used after the first trimester as there has been wide experience in its use for trichomonas in pregnancy.

• #55 Giardia infection (giardiasis) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giardia-infection/diagnosis-treatment/drc-20372790

  Children and adults who have giardia infection without symptoms usually don’t need treatment unless they’re likely to spread the parasites. […] When signs and symptoms are severe or the infection persists, doctors usually treat giardia infection with medications such as: […] Metronidazole is the most commonly used antibiotic for giardia infection. […] Tinidazole works as well as metronidazole and has many of the same side effects, but it can be given in a single dose. […] Nitazoxanide may be easier for children to swallow. […] There are no consistently recommended medications for giardia infection in pregnancy because of the potential for harmful drug effects to the fetus.

• #56 Treatment of Giardia Infection | Giardia | CDC

  https://www.cdc.gov/giardia/treatment/index.html

  A healthcare provider can prescribe medicine to treat Giardia infections. […] You may not need medication to recover from a Giardia infection. […] Many prescription medications are available to treat Giardia infections. […] Therefore, it is important to discuss treatment options with a healthcare provider. […] If you do not have symptoms, you may not need medication for your Giardia infection. […] If you start having symptoms, even if they do not include diarrhea, talk with a healthcare provider to see if they recommend treatment. […] A healthcare provider may also recommend treatment if you live with a pregnant woman. […] If you have a weakened immune system (for example, due to illness such as HIV), your symptoms may last longer. Your healthcare provider can prescribe medications to help reduce the amount of time symptoms last.

• #57 Giardiasis Treatment & Management: Approach Considerations

  https://emedicine.medscape.com/article/176718-treatment

  Routine treatment of infected persons in highly endemic areas where water supplies continue to be contaminated is of questionable value because reinfection may readily occur. Treatment is indicated for all infected persons who live in nonendemic areas. […] If Giardia is found in the patient, a careful history should indicate whether this is a reinfection or a treatment failure. A second course of the same treatment, for a longer duration or a higher dose, should be effective in reinfections, whereas the use of an alternative drug should be used in true treatment failures. Quinacrine-based regimens may be considered if the medication is available. A combination therapy may be considered in certain cases of treatment failure. […] Patients who fail repeated courses of treatment should be evaluated for hypogammaglobulinemia and may require combination therapy or chronic suppressive therapy.

• #58 Giardiasis: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/giardiasis

  Effective ART and anti-parasitic therapy are the primary initial treatments for Giardia infections in children and adults with HIV infection. […] The therapeutic efficacy of metronidazole against Giardia led to development of other nitroimidazole derivatives, such as tinidazole and secnidazole. […] A single, 2-g dose (or the equivalent pediatric dosing of 50 mg/kg in a single dose) of tinidazole has demonstrated cure rates ranging from 80% to 100% and is also associated with improved medication adherence. […] Nitazoxanide is approved in the United States for treatment of infections due to G. duodenalis in patients 1 year or older. […] Metronidazole is the drug most often used for giardiasis treatment worldwide. […] Monitoring and Adverse Events (Including IRIS) […] Patients with chronic diarrhea should be closely monitored for signs and symptoms of volume depletion, electrolyte and weight loss, and malnutrition.

• #59 Giardiasis: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/giardiasis

  The most important steps for management of giardiasis treatment failure are supportive treatment, optimal use of ART to achieve full virologic suppression, and modification of antiparasitic therapy. […] No known pharmacologic interventions effectively prevent recurrence of giardiasis. […] Reinfection can be prevented by consistently practicing good hand hygiene, but particularly after defecation and handling of soiled diapers.

• #60 Patient education: Giardia (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/giardia-beyond-the-basics/print

  Giardia treatment involves taking an antibiotic. The duration of treatment varies depending on the antibiotic given and on whether or not you have a weakened immune system. In most cases, this is enough to eliminate the infection and its symptoms. In stubborn cases that do not improve with the first round of antibiotics, doctors sometimes recommend changing the type, dose, or duration of treatment. […] If you do not have symptoms of Giardia but testing shows that you are infected, you may not need antibiotic treatment. However, children in daycare and people who handle food should be treated for Giardia even if they have no symptoms to prevent the spread of infection. […] Special considerations for children — Antibiotics are the most important part of Giardia treatment both in children and adults, but children sometimes need additional care. Diarrhea can cause dehydration and a salt imbalance, both of which can be especially tough on children. For them, drinks containing electrolytes may be recommended to restore what is lost through diarrhea.

• #61 Giardiasis (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/giardiasis.html

  Giardiasis is treated with prescription medicines that kill the parasites. […] If your child has giardiasis, be sure to give all doses on schedule for as long as your doctor directs. This will help your child recover faster and will kill parasites that might infect others in your family. […] Most kids are better within a week of taking medicine to kill the parasites. Medicine also shortens the time that they’re contagious. If giardiasis isn’t treated, symptoms can last up to 6 weeks or longer.

• #62 Giardiasis – familydoctor.org

  https://familydoctor.org/condition/giardiasis/

  Giardiasis spreads very easily. It’s usually best if a whole family is treated at the same time. In most cases, your doctor will want to check a stool sample after the treatment to be sure the medicine worked. Sometimes you may need to take medicine for a longer time. Or your doctor may want you to take another medicine for a complete cure. […] It is important to treat for dehydration when you have giardiasis. Pregnant women and infants are more likely to get dehydrated when they have diarrhea. Dehydration can be fatal for infants. Talk to your doctor about treatment options if your baby has giardiasis.

• #63 Giardiasis: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/giardiasis

  Giardiasis can be prevented by practicing good hygiene, not drinking or swimming in water that may be contaminated, and not eating food that may be contaminated. […] Frequent hand washing can help reduce the incidence of diarrheal illnesses, including giardiasis. […] Initiating combination antiretroviral therapy (ART) in children with HIV infection to reverse or prevent severe immunodeficiency is the primary intervention to prevent severe enteric giardiasis. […] Tinidazole and nitazoxanide are preferred therapies; metronidazole is the alternative recommended treatment for giardiasis in children. […] Dehydration and electrolyte abnormalities should be corrected. […] Recurrent episodes of giardiasis can be prevented by practicing good hygiene and avoiding contaminated food and water.

• #64 Giardiasis: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/giardiasis

  Effective ART and anti-parasitic therapy are the primary initial treatments for Giardia infections in children and adults with HIV infection. […] The therapeutic efficacy of metronidazole against Giardia led to development of other nitroimidazole derivatives, such as tinidazole and secnidazole. […] A single, 2-g dose (or the equivalent pediatric dosing of 50 mg/kg in a single dose) of tinidazole has demonstrated cure rates ranging from 80% to 100% and is also associated with improved medication adherence. […] Nitazoxanide is approved in the United States for treatment of infections due to G. duodenalis in patients 1 year or older. […] Metronidazole is the drug most often used for giardiasis treatment worldwide. […] Monitoring and Adverse Events (Including IRIS) […] Patients with chronic diarrhea should be closely monitored for signs and symptoms of volume depletion, electrolyte and weight loss, and malnutrition.

• #65 Giardiasis | NT.GOV.AU

  https://nt.gov.au/wellbeing/health-conditions-treatments/digestive-health/giardia

  Anyone with symptoms suggestive of giardiasis should be seen by a doctor. Antibiotics such as tinidazole or metronidazole may be prescribed. […] Management focuses on preventing and treating dehydration caused by vomiting or diarrhoea. Anyone with vomiting or diarrhoea should drink extra fluids to avoid dehydration. Rehydration therapy with oral glucose / electrolyte solution is particularly effective. If children refuse this solution, diluted fruit juice drinks may be given (1 part juice to 4 parts water). […] Children with diarrhoea, who vomit or who refuse extra fluids should see a doctor. Anyone with prolonged or severe diarrhoea or who have symptoms causing concern should see a doctor. […] Medicines to prevent vomiting or diarrhoea should not be given, especially to children, except when prescribed by a doctor.

• #66 SciELO Brazil – Effect of probiotics on giardiasis. Where are we? Effect of probiotics on giardiasis. Where are we?

  https://www.scielo.br/j/bjps/a/Br3dCGL7d8Ws4Sqdp6hJz8B/

  Giardiasis, an intestinal infection caused by Giardia lamblia, was recently included in the Neglected Diseases Initiative by the World Health Organization. Currently, nitroimidazoles are the main class of antibiotic used to treat giardiasis. […] Despite the efficacy of these drugs, adverse effects and reported resistance have increased, encouraging studies to identify and develop therapeutic alternatives. In this context, probiotics may represent an attractive option. Probiotics have been studied as an alternative treatment for giardiasis. […] Based on the studies examined herein, we conclude that probiotics have a beneficial effect on the modulation of giardiasis. […] Among the forms of treatment for giardiasis and its symptoms, the use of drugs such as nitroimidazoles, nitrofurans as well as phytotherapics are commonly highlighted. However, due to an increase in resistance to these compounds, there is an urgent call for the development of novel therapeutic strategies to fight the pathogen in more healthy and effective way. Therefore, nutritional interventions and modifications of the intestinal microenvironment through probiotic administration may be an important therapeutic alternative.

• #67 SciELO Brazil – Effect of probiotics on giardiasis. Where are we? Effect of probiotics on giardiasis. Where are we?

  https://www.scielo.br/j/bjps/a/Br3dCGL7d8Ws4Sqdp6hJz8B/

  Probiotics are considered non-pathogenic microorganisms (bacteria or yeasts) that, when consumed in adequate amounts, produce beneficial effects on the health and well-being of the host. […] The competition for binding sites and available food sources in the intestinal lumen limits pathogen survival in this environment. […] Probiotics have been shown to improve host health by enhancing immune function, reinforcing mucosal barrier function, and reducing mucosal transfer of luminal organisms and metabolites to the host. […] Studies involving the action of probiotics as an alternative therapy on enteric parasites, such as G. lamblia, have been conducted due to their worldwide epidemiological importance as well as because of the damage caused upon the host. […] Recent studies have suggested that probiotics have an anti-Giardia effect and modulate the mucosal immune response.

• #68 SciELO Brazil – Effect of probiotics on giardiasis. Where are we? Effect of probiotics on giardiasis. Where are we?

  https://www.scielo.br/j/bjps/a/Br3dCGL7d8Ws4Sqdp6hJz8B/

  The co-administration of the probiotic and albendazole reduced both the excretion of Giardia cysts in feces and trophozoite counts in the intestinal fluid, and restored villi and crypts to normal morphology. […] Probiotics have a positive action in the treatment of enteric parasite infections, and this benefit may be due to several factors, such as change of intestinal microbiota composition, modulation of immune response, and reduction of host-pathogen interactions.

• #69 Update on Giardiasis: Diagnostics, Treatment, and Management | Today’s Veterinary Practice

  https://todaysveterinarypractice.com/parasitology/update-on-giardiasis-diagnostics-treatment-and-management/

  Follow-up testing at the appropriate time after completion of drug therapy should be considered an essential part of the treatment process. […] Although use of drugs usually minimizes or eliminates clinical disease and in some cases completely eliminates cyst shedding, no drug is consistently 100% effective. […] In practice and in experimental treatment studies, some animals continue to shed cysts at low levels even after treatment and resolution of clinical disease. […] In such cases, lifestyle management and client education are essential for preventing the spread of infection to other pets, minimizing environmental contamination, and promoting public understanding of zoonotic risk.

• #70 Patient Care for Giardia Infection | Giardia | CDC

  https://www.cdc.gov/giardia/hcp/clinical-care/index.html

  Consider inadequate dosing and duration of treatment. […] Consider combination therapy using medications from different classes if Giardia is confirmed by a positive stool test, you have ruled out reinfection and inadequate dosing, and the patient still has symptoms. […] If the patient’s stool samples still remain positive for Giardia even after combination therapy, consider an underlying immunodeficiency that may be preventing the patient from clearing the infection.

• #71 Giardiasis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/intestinal-protozoa-and-microsporidia/giardiasis

  Giardiasis is infection with the flagellated protozoan Giardia duodenalis (G. lamblia, G. intestinalis). […] Treatment is with oral metronidazole, tinidazole, secnidazole, or nitazoxanide. […] For symptomatic giardiasis, tinidazole, metronidazole, secnidazole, or nitazoxanide are used. Treatment failures and resistance can occur with any of them. […] Tinidazole is as effective as metronidazole, but tinidazole is taken in a single dose and metronidazole is taken for 5 to 7 days. […] Secnidazole is given orally as a single dose. […] Nitazoxanide is available in liquid form, which is useful for children, and as tablets. It is taken for 3 days. […] Furazolidone, quinacrine, or albendazole are rarely used because of potential toxicity, lower efficacy, or cost. […] Even after parasitologic cure, patients may experience lactose intolerance, irritable bowel syndrome, or fatigue that last for weeks to months. […] For symptomatic patients, use tinidazole, metronidazole, secnidazole, or nitazoxanide. […] Symptoms may persist after parasite clearance.

• #72 Giardiasis: What It Is, Symptoms, Treatments & Medications

  https://my.clevelandclinic.org/health/diseases/15238-giardiasis

  Giardiasis is a common illness caused by a parasite that may result in diarrhea and stomach cramps. Antibiotics can treat giardiasis. […] A healthcare provider can prescribe antiparasitic medications for giardiasis if you need them. […] Not everyone will need treatment for giardiasis. But if you have symptoms, your healthcare provider can prescribe antiparasitic medications to make the infection go away faster. With medications, most people feel better within a week. […] Antibiotics for giardiasis include: Metronidazole (Flagyl), Tinidazole (Tindamax), Nitazoxanide (Alinia), Paromomycin (Humatin). […] If your provider prescribes antibiotics, it’s important to take the full course to make sure the infection doesn’t rebound. […] If you continue to have symptoms for longer than six weeks, visit your healthcare provider. They can test you to find out if you’re still infected, or if your symptoms are due to the after-effects of the infection. They can offer treatment for either the infection itself or your symptoms and screen you for complications. […] If you’ve taken antibiotics but testing later finds you’re still infected, it’s possible that you need a different medication or combination.

• #73 Giardia | Healthify

  https://healthify.nz/health-a-z/g/giardia

  Giardia infection (giardiasis) is a form of gastroenteritis (gastro) caused by a gut parasite. […] If your doctor decides that you do need treatment, you may be prescribed antibiotics such as ornidazole or metronidazole, which kill the parasite in your poo and prevent the spread of the infection. […] Many people develop a temporary milk intolerance after giardiasis, so you may find it best not to consume milk and lactose-containing foods for approximately one month after treatment.

• #74 Treatment-refractory giardiasis: challenges and solutions | IDR

  https://www.dovepress.com/treatment-refractory-giardiasis-challenges-and-solutions-peer-reviewed-fulltext-article-IDR

  Giardia is the commonest parasitic diarrheal pathogen affecting humans and a frequent cause of waterborne/foodborne parasitic diseases worldwide. […] An alarming increase in cases refractory to the conventional treatment with nitroimidazoles (ie, metronidazole) has been reported in low prevalence settings, such as European Union countries, especially in patients returning from Asia. […] In low-prevalence settings, treatment of confirmed cases of giardiasis is always recommended to cure symptoms and shorten the course of the disease. […] A Cochrane review in 2012 identified a total of only 19 randomized controlled trials (RCTs) comparing metronidazole (MTZ) administered for 5-10 days with any of the following drugs: MTZ (single dose), tinidazole, albendazole (ABZ), mebendazole, and nitazoxanide.

• #75 Treatment-refractory giardiasis: challenges and solutions | IDR

  https://www.dovepress.com/treatment-refractory-giardiasis-challenges-and-solutions-peer-reviewed-fulltext-article-IDR

  Regardless of the drug and the regimen used, a 100% parasitological cure rate is rarely achieved, implying that failure in clinical treatment of some giardiasis cases is to be considered. […] The possibility to test or confirm drug resistance in clinical isolates is strongly hampered by the well-documented difficulty to establish routine cultures. […] Treatment-refractory cases of giardiasis have been observed by clinicians for decades. […] Five decades of Giardia susceptibility to MTZ treatment is now replaced by increasing resistance, and the refractory giardiasis cases has also been reported after treatment with all other available drugs. […] The low success rate of monotherapy in treatment failure cases may be indicative of cross-resistance, as proved in vitro between MTZ and tinidazole, MTZ and ABZ, as well as between nitazoxanide and quinacrine.

• #76

  https://journals.lww.com/co-infectiousdiseases/fulltext/2020/10000/giardiasis_treatment__an_update_with_a_focus_on.6.aspx

  The first-line treatment of giardiasis is the 5-nitroimidazoles, but there are reports of high incidence of nitroimidazole refractory cases of giardiasis. […] Drug trials have usually shown efficacy above 90% for the nitroimidazoles; however, treatment refractory disease is an increasing problem. […] Quinacrine is effective in almost all cases, but due to availability problems and potentially severe side effects, the drug is normally preferred only when other treatment options fail. […] Combination of drugs from different classes also seems to be an effective second-line option. […] Nitroimidazole failure in up to 50% is reported in giardiasis, both among travelers and in high endemic countries. Repeated courses of nitroimidazole, and monotherapy with a drug with another mode of action, seem to be less effective than combination therapy.

• #77

  https://link.springer.com/article/10.1007/s11908-014-0396-y

  Auranofin demonstrated in vivo and in vitro antigiardial activity, including against metronidazole-resistant strains. […] Orlistat inhibited in vitro growth of Giardia much more effectively than metronidazole and there was no demonstrated antagonism between the two agents, suggesting a potential combination therapy. […] Miltefosine is an antileishmanial drug that in a mouse model induced severe morphological changes in Giardia trophozoites. […] New approaches to the treatment of giardiasis.

• #78

  https://link.springer.com/article/10.1007/s11908-014-0396-y

  Giardiasis is a common yet neglected cause of diarrheal illness worldwide. Antimicrobial therapy is usually but not always effective and drug resistance has become an increasing concern. Several promising drug candidates have been recently identified that can overcome antibiotic resistance in Giardia. These include derivatives of 5-nitroimidazoles and benzimidazoles, as well as hybrid compounds created from combinations of different antigiardial drugs. High-throughput screening of large compound libraries has been a productive strategy for identifying antigiardial activity in drugs already approved for other indications, e.g. auranofin. This article reviews the current treatment of giardiasis, mechanisms of resistance, advances in drug and vaccine development, and directions for further research on this significant human pathogen.

• #79

  https://link.springer.com/article/10.1007/s11908-014-0396-y

  Auranofin demonstrated in vivo and in vitro antigiardial activity, including against metronidazole-resistant strains. […] Orlistat inhibited in vitro growth of Giardia much more effectively than metronidazole and there was no demonstrated antagonism between the two agents, suggesting a potential combination therapy. […] Miltefosine is an antileishmanial drug that in a mouse model induced severe morphological changes in Giardia trophozoites. […] New approaches to the treatment of giardiasis.

• #80 Giardiasis (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/giardiasis

  Giardiasis treatment and management: […] Treatment is required where there are giardiasis symptoms, or where there is risk of infection of others who are at special risk. […] Drug treatment for giardiasis: Rehydration, if required. […] Clinical Knowledge Summaries (CKS) recommend tinidazole as the drug of choice for treating giardiasis but metronidazole is recommended first-line by the British National Formulary. […] The other drug recommended by the British National Formulary (BNF) is mepacrine (unlicensed). […] Mebendazole also has some effect against Giardia spp. […] Metronidazole resistance is becoming an increasing problem. Treatment failures are reported in up to 20% of cases and this has led to the search for alternatives. Auranofin, an antirheumatic agent, has shown promising results. […] Development of new drugs based on modification of 5-nitroimidazole, the core structure of metronidazole and other molecular targets of Giardia spp. is ongoing.

• #81 Update on Giardiasis: Diagnostics, Treatment, and Management | Today’s Veterinary Practice

  https://todaysveterinarypractice.com/parasitology/update-on-giardiasis-diagnostics-treatment-and-management/

  Update on Giardiasis: Diagnostics, Treatment, and Management […] Treatment of giardiasis continues to be challenging, and even when clinical signs are resolved, treatment often fails to completely eliminate cyst shedding. […] The greatest chance for successful treatment and minimizing reinfection risk involves an integrated treatment approach, including efforts to decontaminate the pet and the pet’s environment, controlling cyst dissemination, and drug therapy. […] Although no drug is officially labeled for treatment, extended-duration fenbendazole alone or in combination with metronidazole are the first-choice treatments for giardiasis; however, a number of drugs have been used experimentally when first-choice treatments fail to eliminate clinical signs. […] The primary goals of treatment should be resolving clinical signs, educating clients regarding their pet’s infection status, and creating an appropriate management plan with clients.

• #82 Update on Giardiasis: Diagnostics, Treatment, and Management | Today’s Veterinary Practice

  https://todaysveterinarypractice.com/parasitology/update-on-giardiasis-diagnostics-treatment-and-management/

  Although total clearance of infection is certainly an ideal goal, for many patients it is unattainable. […] All treatment regimens should involve an integrated approach, should not rely on drugs alone, and should include measures such as picking up feces, monitoring where the pet defecates, washing bedding, decontaminating hard surfaces, routinely bathing the pet, and promoting overall gut health with nutritional therapies including a high-fiber diet and probiotics. […] There is now an oral suspension formulation of metronidazole which has been approved by the U.S. Food and Drug Administration for treatment of giardiasis in dogs and can be integrated into existing treatment regimens where appropriate. […] The true cause of perceived drug resistance is most often reinfection; however, there are cases in which reinfection has been ruled out and clinical Giardia infection persists.

• #83 Giardiasis: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/giardiasis

  The most important steps for management of giardiasis treatment failure are supportive treatment, optimal use of ART to achieve full virologic suppression, and modification of antiparasitic therapy. […] No known pharmacologic interventions effectively prevent recurrence of giardiasis. […] Reinfection can be prevented by consistently practicing good hand hygiene, but particularly after defecation and handling of soiled diapers.

• #84 Giardia: Infection, treatment and prevention | Cornell University College of Veterinary Medicine

  https://www.vet.cornell.edu/departments-centers-and-institutes/riney-canine-health-center/canine-health-information/giardia-infection-treatment-and-prevention

  Common household disinfectants and steam-cleaning are the most effective ways for killing Giardia cysts. […] With proper treatment, most dogs fully recover from giardiasis. […] If diarrhea continues after treatment, your veterinarian may need to recheck a stool sample to see whether your dog has been reinfected. […] Dogs may become reinfected if their surrounding environment is not properly managed. Additionally, if the Giardia is resistant to the medication used or if the medication was not dosed properly, then refractory infections may also occur.

• #85 Giardiasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513239/

  Giardiasis, caused by the protozoa Giardia duodenalis (also called Giardia intestinalis and Giardia lamblia), is a prevalent small intestinal infection marked by symptoms such as watery diarrhea and flatulence. This activity reviews the evaluation and treatment strategies for giardiasis, emphasizing the crucial role of the interprofessional healthcare team in enhancing patient care. […] The standard treatment for giardiasis involves antibiotic therapy, with metronidazole being the first-line treatment for this condition. […] However, metronidazole has challenges, including significant failure rates in clearing protozoa from the intestine and issues related to patient compliance. […] Alternative treatment regimens for giardiasis include tinidazole, nitazoxanide, mebendazole, albendazole, and paromomycin.

• #86 Giardiasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513239/

  Conflicting data exists regarding the most effective treatment for giardiasis. […] Generally, asymptomatic individuals do not require treatment, except in cases where it is necessary to prevent household transmission, especially from toddlers to pregnant women or patients with cystic fibrosis. Treatment is also recommended for patients with malabsorption associated with Giardia intestinalis who require oral antibiotics for other infections. […] The prognosis for patients with giardiasis is generally excellent, as most infections are self-limited. […] Several antibiotics are available and are reasonably successful in shortening the illness duration, although drug resistance has been reported in clinical cases.

• #87 Giardiasis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/intestinal-protozoa-and-microsporidia/giardiasis

  Giardiasis is infection with the flagellated protozoan Giardia duodenalis (G. lamblia, G. intestinalis). […] Treatment is with oral metronidazole, tinidazole, secnidazole, or nitazoxanide. […] For symptomatic giardiasis, tinidazole, metronidazole, secnidazole, or nitazoxanide are used. Treatment failures and resistance can occur with any of them. […] Tinidazole is as effective as metronidazole, but tinidazole is taken in a single dose and metronidazole is taken for 5 to 7 days. […] Secnidazole is given orally as a single dose. […] Nitazoxanide is available in liquid form, which is useful for children, and as tablets. It is taken for 3 days. […] Furazolidone, quinacrine, or albendazole are rarely used because of potential toxicity, lower efficacy, or cost. […] Even after parasitologic cure, patients may experience lactose intolerance, irritable bowel syndrome, or fatigue that last for weeks to months. […] For symptomatic patients, use tinidazole, metronidazole, secnidazole, or nitazoxanide. […] Symptoms may persist after parasite clearance.

• #88 Treatment-refractory giardiasis: challenges and solutions | IDR

  https://www.dovepress.com/treatment-refractory-giardiasis-challenges-and-solutions-peer-reviewed-fulltext-article-IDR

  An early study with six treatment-refractory cases, four of which had confirmed immunodeficiency, found a combination of quinacrine and MTZ to be effective in five of the cases, and the sixth case finally responded to a 3-week course of quinacrine and tinidazole. […] The increasing resistance toward the NIs is alarming as it prolongs the illness period and the treatment cost for giardiasis.

• #89

  https://journals.lww.com/co-infectiousdiseases/fulltext/2020/10000/giardiasis_treatment__an_update_with_a_focus_on.6.aspx

  Giardiasis remains a common cause of diarrhea and intestinal enteropathy globally. Here we give an overview of clinical treatment studies and discuss potential mechanisms and molecular targets for in-vitro testing of drug resistance. […] The prevalence of treatment refractory giardiasis is increasing. Recent studies reveal 5-nitroimidazole refractory infection occurs in up to 50% of cases. […] Based on the clinical studies reported, combination treatment with a 5-nitroimidazole and a benzimidazole is more effective than repeated courses of 5-nitroimidazole or monotherapies in refractory cases. […] A combination of a 5-nitroimidazole and albendazole or mebendazole, and quinacrine monotherapy, are rational choices in nitroimidazole refractory infections, but randomized controlled studies are needed.

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