Materiały źródłowe

• #1 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.

• #2 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.

• #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 & Management: Approach Considerations

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

  Generally, treatment is not needed for asymptomatic persons who excrete the organism, except to prevent household transmission and to permit adequate treatment in individuals with possible Giardia intestinalis-associated antibiotic malabsorption who require oral antibiotic treatment for other infections. 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. […] Ensure that close contacts of the patient are also examined for giardiasis and treated if infected. Severely dehydrated or malnourished patients should be admitted for further care. […] No consistent recommendations exist for the treatment of pregnant patients because of the potential adverse effects of anti-Giardia agents on the fetus. If treatment is necessary, paromomycin is an effective treatment with poor systemic absorption. Documenting the continued presence of Giardia in patients who appear unresponsive to treatment is important.

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

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

  Treatment for Giardia 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.

• #6 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.

• #7 Giardiasis – StatPearls – NCBI Bookshelf

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

  Real-time PCR can be valuable in evaluating treatment efficacy. Research by Van den Bijllaardt et al revealed that samples typically turned negative approximately 1 week after treatment, indicating rapid clearance following successful therapy. […] The standard dosing for metronidazole is as follows: 250 to 500 mg 3 times a day for 5 to 10 days. Research suggests that once-daily dosing could be equally effective. Caution is advised when administering metronidazole to pregnant women, especially during the first trimester, due to the potential risks of cleft lip formation. Patients should be counseled on avoiding alcohol consumption to prevent the disulfiram effect, which includes symptoms such as flushing, headaches, and nausea. […] Metronidazole is safe for children, and a typical dose is 30 mg/kg to 50 mg/kg per day divided into 3 doses. It is recommended to treat children experiencing failure to thrive with acute or chronic diarrhea, malabsorption, or other GI symptoms when Giardia organisms have been identified.

• #8 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.

• #9 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.

• #10 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.

• #11 What’s the most effective treatment for giardiasis? | MDedge

  https://mdedge.com/jfponline/article/63098/infectious-diseases/whats-most-effective-treatment-giardiasis

  A single 2-g dose of tinidazole is the best treatment (strength of recommendation [SOR]: A, based on meta-analysis). Other drugs, such as nitazoxanide, metronidazole, mebendazole, and albendazole, can also be used (SOR: A, based on randomized controlled trial [RCT] of patient-oriented outcomes), but tinidazole has a higher clinical cure rate than these drugs. […] Tinidazole is the treatment of choice. […] The review found that a single dose of tinidazole had a higher clinical cure rate than other therapies such as metronidazole (odds ratio [OR]=5.33; 95% confidence interval [CI], 2.66-10.67) along with a comparable side-effect profile. These findings favor tinidazole as the treatment of choice for symptomatic giardiasis.

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

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

  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. […] Dehydration due to diarrhea is a particular risk for pregnant women and infants. Rehydration therapy is especially important for these groups.

• #13 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.

• #14 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. […] 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. Combination therapy can be safe, effective, and useful in the case of treatment failure.

• #15 Giardiasis: Causes, Symptoms, and Treatment

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

  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.

• #16 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.

• #17 Giardiasis – Wikipedia

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

  Both medications need a five to ten-day-long course; albendazole is taken once a day, while metronidazole needs to be taken three times a day. […] 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.

• #18 Giardiasis – StatPearls – NCBI Bookshelf

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

  Alternative treatment regimens for giardiasis include tinidazole, nitazoxanide, mebendazole, albendazole, and paromomycin. Paromomycin, which has poor systemic absorption, could be considered for a pregnant patient during her first trimester. […] Conflicting data exists regarding the most effective treatment for giardiasis. A systematic review found that albendazole may be as effective as metronidazole with fewer side effects. If patients experience persistent symptoms despite therapy, a medication from another class should be used. […] 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 G intestinalis who require oral antibiotics for other infections. Close contacts of the infected individual for giardiasis should be assessed and treated if infected.

• #19 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. Appropriate fluid and electrolyte management is critical, particularly in patients with large-volume diarrheal losses. 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.

• #20 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.

• #21 Giardiasis – Wikipedia

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

  Both medications need a five to ten-day-long course; albendazole is taken once a day, while metronidazole needs to be taken three times a day. […] 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.

• #22 Treatment of Children with Giardia lamblia Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0915/p1069a.html

  The drugs commonly used for treatment of G. lamblia in children include metronidazole, quinacrine, furazolidone and paromomycin. […] Cure rates range from 80 to 100 percent but, in older children, are usually lower with furazolidone than with metronidazole and quinacrine. […] Metronidazole is the drug most commonly used in adults to treat G. lamblia infection although it is not approved by the U.S. Food and Drug Administration (FDA) for this indication. […] Cure rates range from 60 to 100 percent. […] Paromomycin is a nonabsorbed aminoglycoside that is preferred in situations where absorption of a drug is undesirable (e.g., during pregnancy). […] If standard therapeutic regimens fail because of immunodeficiency or other issues, combinations of metronidazole and quinacrine can be administered for three weeks. […] The author concludes that all symptomatic or likely symptomatic patients should be treated. Treatment should also be considered in asymptomatic patients who may be a source of infection to others.

• #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 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. […] We propose a working definition of clinically drug-resistant giardiasis, summarize knowledge regarding resistance mechanisms, and discuss its clinical management according to research-based evidence and medical practice. […] No effective and approved human vaccine against giardiasis is available, and pharmacotherapy is the only available option to treat giardiasis. […] A Cochrane review in 2012 identified a total of only 19 randomized controlled trials (RCTs) comparing metronidazole (MTZ) administered for 510 days with any of the following drugs: MTZ (single dose), tinidazole, albendazole (ABZ), mebendazole, and nitazoxanide.

• #25 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.

• #26 Giardiasis Medication: Antibiotics

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

  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. […] The two major classes of drugs that have proven benefit in the treatment of giardiasis are nitroimidazole derivatives and acridine dyes. […] Although most experts recommend metronidazole and tinidazole as the drugs of choice because the brief treatment periods encourage good patient adherence, treatment failures occur in as many as 40% of cases, probably due to resistance. […] The effectiveness of quinacrine is similar to that of nitroimidazole derivatives; however, it is less tolerated because of its adverse effects.

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

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

  In treatment-refractory giardiasis, monotherapy with a longer duration or higher dose of the same drug or treatment with new alternate drugs generally has a poorer success rate than the initial treatment for any given drug. […] Remarkably, quinacrine is the only drug proved successful in several studies as monotherapy in treatment failure cases of giardiasis, with a near 100% cure rate. […] Clinical experience of low efficacy of monotherapy has led to the use of combinations of drugs in cases of initial treatment failure. […] If drugs of the main classes fail, one may resort to drugs with a different mechanism of action. […] The increasing resistance toward the NIs is alarming as it prolongs the illness period and the treatment cost for giardiasis. […] The main challenge in treatment-refractory giardiasis is understanding of its mechanisms of resistance and an evidence base for its clinical management. […] Probiotics, or their released peptides, in view of several promising studies, should be investigated as a potentially effective alternative or supportive therapy against drug-resistant Giardia strains or in the management of treatment-refractory cases.

• #28

  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.

• #29

  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. A combination of a 5-nitroimidazole and albendazole or mebendazole, and quinacrine as last option, are rational choices in nitroimidazole refractory infections.

• #30 Treatment of Children with Giardia lamblia Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0915/p1069a.html

  The drugs commonly used for treatment of G. lamblia in children include metronidazole, quinacrine, furazolidone and paromomycin. […] Cure rates range from 80 to 100 percent but, in older children, are usually lower with furazolidone than with metronidazole and quinacrine. […] Metronidazole is the drug most commonly used in adults to treat G. lamblia infection although it is not approved by the U.S. Food and Drug Administration (FDA) for this indication. […] Cure rates range from 60 to 100 percent. […] Paromomycin is a nonabsorbed aminoglycoside that is preferred in situations where absorption of a drug is undesirable (e.g., during pregnancy). […] If standard therapeutic regimens fail because of immunodeficiency or other issues, combinations of metronidazole and quinacrine can be administered for three weeks. […] The author concludes that all symptomatic or likely symptomatic patients should be treated. Treatment should also be considered in asymptomatic patients who may be a source of infection to others.

• #31 Giardiasis Treatment & Management: Approach Considerations

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

  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.

• #32

  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.

• #33 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.

• #34

  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.

• #35

  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.

• #36 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. […] 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. […] Therefore, nutritional interventions and modifications of the intestinal microenvironment through probiotic administration may be an important therapeutic alternative.

• #37 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. […] Some studies suggest that the effective therapeutic dose for health benefits is 5 billion colony forming units a day (5 x 10^9 CFU/day) for at least five days. […] 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. […] 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.

• #38 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 authors concluded that L. acidophilus (P106) derived bacteriocin should be a great promise as a potential therapeutic safe alternative to existing commercial drugs. […] 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.

• #39 Giardiasis – StatPearls – NCBI Bookshelf

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

  Real-time PCR can be valuable in evaluating treatment efficacy. Research by Van den Bijllaardt et al revealed that samples typically turned negative approximately 1 week after treatment, indicating rapid clearance following successful therapy. […] The standard dosing for metronidazole is as follows: 250 to 500 mg 3 times a day for 5 to 10 days. Research suggests that once-daily dosing could be equally effective. Caution is advised when administering metronidazole to pregnant women, especially during the first trimester, due to the potential risks of cleft lip formation. Patients should be counseled on avoiding alcohol consumption to prevent the disulfiram effect, which includes symptoms such as flushing, headaches, and nausea. […] Metronidazole is safe for children, and a typical dose is 30 mg/kg to 50 mg/kg per day divided into 3 doses. It is recommended to treat children experiencing failure to thrive with acute or chronic diarrhea, malabsorption, or other GI symptoms when Giardia organisms have been identified.

• #40 Giardiasis: Causes, Symptoms, and Treatment

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

  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.

• #41 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. […] Supportive care with hydration, correction of electrolyte abnormalities, and nutritional supplementation should be provided. […] 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.

• #42 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. […] Supportive care with hydration, correction of electrolyte abnormalities, and nutritional supplementation should be provided. […] 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.

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

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

  Treatment for Giardia 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.

• #44 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.

• #45 How to Treat Giardia During Pregnancy | American Pregnancy Association

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-health-wellness/treat-giardia-pregnancy/

  How to Treat Giardia During Pregnancy […] Giardia lamblia is a parasite found in soil, food, human or animal waste, and untreated water in developed countries. It is best to prevent contraction of Giardia during pregnancy in the first place. Make sure to boil or filter all untreated water, such as a stream or well water, before you drink it. […] Some people notice their symptoms disappear without any medical intervention. For those whose symptoms persist, there seem to be no known natural remedies for giardiasis. […] It is likely your doctor will delay treatment until after your baby is born. Many of the drugs used to treat giardiasis are not safe to take during pregnancy. […] During pregnancy, your doctor may advise that you limit treatment to treating the symptoms associated with your infection. […] If your Giardiasis is severe, your doctor may prescribe paromomycin. Alternatively, your doctor may prescribe metronidazole. […] This medicine is safe to take throughout pregnancy. Once the disease becomes mild, your doctor may choose to put off treatment until after your baby is born or if you are taking metronidazole, after the first trimester.

• #46 Giardiasis Guide: Causes, Symptoms and Treatment Options

  https://www.drugs.com/health-guide/giardiasis.html

  The following list of medications are related to or used in the treatment of this condition. […] Commonly prescribed medications used to treat Giardia infection include tinidazole (Tindamax), nitazoxanide (Alinia), and metronidazole (Flagyl). […] If you don’t receive treatment for a Giardia infection, you will probably eventually recover on your own. However, treatment is a good idea for anyone who is having symptoms. Treatment can also help if you don’t have symptoms because treatment can prevent the spread of infection to others. This is especially true for children and for people who prepare or serve food. […] A doctor should examine and consider treatment for sexual partners and people who have had close contact with the infected person, such as household members, even if they have no symptoms. Pregnant women generally are not treated with medications during the first trimester. […] If you have giardiasis, be sure to drink plenty of fluids to prevent dehydration. Over-the-counter medications for diarrhea, such as loperamide (Imodium), may help your symptoms. Wash your hands frequently if you have giardiasis or if you are caring for a person or animal with this infection.

• #47 Giardiasis Treatment & Management: Approach Considerations

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

  Generally, treatment is not needed for asymptomatic persons who excrete the organism, except to prevent household transmission and to permit adequate treatment in individuals with possible Giardia intestinalis-associated antibiotic malabsorption who require oral antibiotic treatment for other infections. 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. […] Ensure that close contacts of the patient are also examined for giardiasis and treated if infected. Severely dehydrated or malnourished patients should be admitted for further care. […] No consistent recommendations exist for the treatment of pregnant patients because of the potential adverse effects of anti-Giardia agents on the fetus. If treatment is necessary, paromomycin is an effective treatment with poor systemic absorption. Documenting the continued presence of Giardia in patients who appear unresponsive to treatment is important.

• #48 Giardiasis – Wikipedia

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

  Both medications need a five to ten-day-long course; albendazole is taken once a day, while metronidazole needs to be taken three times a day. […] 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.

• #49 How to Treat Giardia During Pregnancy | American Pregnancy Association

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-health-wellness/treat-giardia-pregnancy/

  How to Treat Giardia During Pregnancy […] Giardia lamblia is a parasite found in soil, food, human or animal waste, and untreated water in developed countries. It is best to prevent contraction of Giardia during pregnancy in the first place. Make sure to boil or filter all untreated water, such as a stream or well water, before you drink it. […] Some people notice their symptoms disappear without any medical intervention. For those whose symptoms persist, there seem to be no known natural remedies for giardiasis. […] It is likely your doctor will delay treatment until after your baby is born. Many of the drugs used to treat giardiasis are not safe to take during pregnancy. […] During pregnancy, your doctor may advise that you limit treatment to treating the symptoms associated with your infection. […] If your Giardiasis is severe, your doctor may prescribe paromomycin. Alternatively, your doctor may prescribe metronidazole. […] This medicine is safe to take throughout pregnancy. Once the disease becomes mild, your doctor may choose to put off treatment until after your baby is born or if you are taking metronidazole, after the first trimester.

• #50 Giardiasis – StatPearls – NCBI Bookshelf

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

  Real-time PCR can be valuable in evaluating treatment efficacy. Research by Van den Bijllaardt et al revealed that samples typically turned negative approximately 1 week after treatment, indicating rapid clearance following successful therapy. […] The standard dosing for metronidazole is as follows: 250 to 500 mg 3 times a day for 5 to 10 days. Research suggests that once-daily dosing could be equally effective. Caution is advised when administering metronidazole to pregnant women, especially during the first trimester, due to the potential risks of cleft lip formation. Patients should be counseled on avoiding alcohol consumption to prevent the disulfiram effect, which includes symptoms such as flushing, headaches, and nausea. […] Metronidazole is safe for children, and a typical dose is 30 mg/kg to 50 mg/kg per day divided into 3 doses. It is recommended to treat children experiencing failure to thrive with acute or chronic diarrhea, malabsorption, or other GI symptoms when Giardia organisms have been identified.

• #51 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.

• #52 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.

• #53 Giardiasis Treatment & Management: Approach Considerations

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

  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.

• #54 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.

• #55 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.

• #56 Giardiasis – StatPearls – NCBI Bookshelf

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

  Most patients presenting with giardiasis are nontoxic and may necessitate only oral rehydration for initial fluid resuscitation. In severe cases, intravenous (IV) fluids might be necessary. Proper fluid and electrolyte management is crucial, particularly in large-volume diarrheal losses. […] 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. Moreover, an escalating incidence of nitroimidazole-refractory infection has been reported, especially among travelers from India and other Asian countries. Determining an optimal treatment strategy for such cases of giardiasis remains an ongoing challenge.

• #57 Giardiasis – NYC Health

  https://www.nyc.gov/site/doh/health/health-topics/giardiasis.page

  People with giardiasis should drink plenty of fluids, especially young children and pregnant women. […] Healthy people usually recover on their own without medication. Medicines for treatment such as metronidazole, tinidazole or nitazoxanide can be prescribed by a health care provider.

• #58 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.

• #59 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. […] Supportive care with hydration, correction of electrolyte abnormalities, and nutritional supplementation should be provided. […] 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.

• #60 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.

• #61 Giardia infection (giardiasis)

  https://www.healthywa.wa.gov.au/Articles/F_I/Giardia-infection

  Consult your doctor for treatment, as prescription medications such as antibiotics are usually required. Chronic infection can last for months to years if left undiagnosed and untreated. […] Avoid anti-vomiting or anti-diarrhoeal medications unless a doctor has prescribed or recommended them for you.

• #62 Giardia in Dogs: Symptoms & Treatment

  https://vcahospitals.com/know-your-pet/giardia-in-dogs

  Giardiasis can be a significant cause of illness, especially diarrhea, in animals and people. […] The most common drugs used to kill Giardia are fenbendazole (Panacur) and metronidazole. These drugs are usually given for three to ten days to treat giardiasis. Both drugs may be given in combination if necessary. This combination is usually administered to dogs with refractory diarrhea (diarrhea that hasn’t responded to treatment). Supportive treatment with other drugs may be needed as supplemental therapy if dehydration or severe diarrhea is present. […] A low-residue, highly digestible diet may help lessen loose stools during treatment. Some dogs may require follow-up tests and treatments based on their condition and severity of infection. All infected pets should be re-tested two to four weeks after completion of treatment. Your veterinarian will help determine the treatment best for your pet.

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

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

  Even after parasitologic cure, patients may experience lactose intolerance, irritable bowel syndrome, or fatigue that last for weeks to months. […] Guidelines for managing recurrent giardiasis infections and treatment failures are available. […] For symptomatic patients, use tinidazole, metronidazole, secnidazole, or nitazoxanide.

• #64 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. […] Recurrence of symptoms — 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.

• #65 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.

• #66 Giardiasis – Wikipedia

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

  Both medications need a five to ten-day-long course; albendazole is taken once a day, while metronidazole needs to be taken three times a day. […] 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.

• #67 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. […] Recurrence of symptoms — 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.

• #68 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. […] Recurrence of symptoms — 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.

• #69 Giardiasis in Dogs : Understanding Giardia in Dogs

  https://todaysveterinarypractice.com/parasitology/giardiasis-in-dogs/

  Dogs with giardiasis can experience a range of clinical signs, including diarrhea, but a significant proportion are asymptomatic. […] No drugs are approved for the treatment of giardiasis in dogs in the United States. The Companion Animal Parasite Council recommends the following: Metronidazole (10 to 25 mg/kg q12h for 5 to 8 days) or Fenbendazole (50 mg/kg q24h for 3 to 5 days) or A combination of fenbendazole (50 mg/kg q24h) and metronidazole (25 mg/kg q12h) for 5 days. […] Fenbendazole is approved for the treatment of giardiasis in dogs in Europe. The use of a combination product consisting of febantel, praziquantel, and pyrantel temporarily stopped cyst shedding in dogs, but there are not much additional data supporting this treatment. […] Albendazole has been used in the treatment of giardiasis; however, there is apprehension about using this drug owing to potential bone marrow toxicity. […] The primary goal of giardiasis treatment is to resolve diarrhea. Elimination of infection is desired but is much more difficult to achieve. […] Follow-up investigation can be done 24 to 48 hours after the completion of treatment.

• #70 Giardiasis Treatment & Management: Approach Considerations

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

  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.

• #71 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. […] Recurrence of symptoms — 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.

• #72 Giardiasis – StatPearls – NCBI Bookshelf

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

  Real-time PCR can be valuable in evaluating treatment efficacy. Research by Van den Bijllaardt et al revealed that samples typically turned negative approximately 1 week after treatment, indicating rapid clearance following successful therapy. […] The standard dosing for metronidazole is as follows: 250 to 500 mg 3 times a day for 5 to 10 days. Research suggests that once-daily dosing could be equally effective. Caution is advised when administering metronidazole to pregnant women, especially during the first trimester, due to the potential risks of cleft lip formation. Patients should be counseled on avoiding alcohol consumption to prevent the disulfiram effect, which includes symptoms such as flushing, headaches, and nausea. […] Metronidazole is safe for children, and a typical dose is 30 mg/kg to 50 mg/kg per day divided into 3 doses. It is recommended to treat children experiencing failure to thrive with acute or chronic diarrhea, malabsorption, or other GI symptoms when Giardia organisms have been identified.

• #73 Companion Animal Parasite Council | Giardia

  https://capcvet.org/guidelines/giardia/

  Albendazole is effective against Giardia but is not safe in dogs and should not be used. […] Environmental considerations include bathing the pet and removing fecal matter and fecal contaminated materials. […] Insufficient evidence is available for definitive recommendations in each clinical scenario; however, the majority opinion of the CAPC Board is that asymptomatic dogs may not require treatment. […] Follow up testing may be done 24-48 hours after the completion of therapy if clinical signs have not resolved. […] It is recommended to perform a fecal flotation with centrifugation primarily for detection of cysts in solid or semisolid stools. […] ELISA and PCR tests may remain positive even after treatment for variable periods of time and should not be used as a guide to determine reinfection or failure of treatment.

• #74 Companion Animal Parasite Council | Giardia

  https://capcvet.org/guidelines/giardia/

  Treatment failures may result from: reinfection, inadequate drug levels, immunosuppression, drug resistance and Giardia sequestration in the gallbladder or pancreatic ducts. […] The presence of immunosuppression, reinfection, or sequestration can usually be determined in a clinical setting. […] Certain immunosuppressed patients are abnormally susceptible to giardiasis and their infections are often difficult to cure. […] Reinfection is common in endemic regions with high environmental contamination. […] Concomitant with treatment, animals should be bathed with shampoo to remove fecal debris and associated cysts on the last day of treatment. […] Remove feces daily and dispose of fecal material with municipal waste. […] Environmental areas (e.g., soil, grass, standing water) are difficult to decontaminate, but surfaces can be sanitized by steam-cleaning or use of commercially available disinfectants. […] Allow surfaces to dry thoroughly after cleaning. […] Post-treatment fecal examination by zinc sulfate centrifugation may be helpful in evaluating the success of therapy.

• #75 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.

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

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

  Antibiotics can treat giardiasis. […] A healthcare provider can prescribe antiparasitic medications for giardiasis if you need them. […] 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. […] Different medications affect different people in different ways. […] If your first prescription doesn’t work or causes intolerable side effects, your provider will offer an alternative. […] If you continue to have symptoms for longer than six weeks, visit your healthcare provider. […] They can offer treatment for either the infection itself or your symptoms and screen you for complications. […] If your provider prescribes antibiotics, it’s important to take the full course to make sure the infection doesn’t rebound. […] If necessary, your provider will consult an infectious disease specialist to devise an individualized treatment plan for you that combines different types of medications.

• #77 Companion Animal Parasite Council | Giardia

  https://capcvet.org/guidelines/giardia/

  Treatment failures may result from: reinfection, inadequate drug levels, immunosuppression, drug resistance and Giardia sequestration in the gallbladder or pancreatic ducts. […] The presence of immunosuppression, reinfection, or sequestration can usually be determined in a clinical setting. […] Certain immunosuppressed patients are abnormally susceptible to giardiasis and their infections are often difficult to cure. […] Reinfection is common in endemic regions with high environmental contamination. […] Concomitant with treatment, animals should be bathed with shampoo to remove fecal debris and associated cysts on the last day of treatment. […] Remove feces daily and dispose of fecal material with municipal waste. […] Environmental areas (e.g., soil, grass, standing water) are difficult to decontaminate, but surfaces can be sanitized by steam-cleaning or use of commercially available disinfectants. […] Allow surfaces to dry thoroughly after cleaning. […] Post-treatment fecal examination by zinc sulfate centrifugation may be helpful in evaluating the success of therapy.

• #78 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. […] We propose a working definition of clinically drug-resistant giardiasis, summarize knowledge regarding resistance mechanisms, and discuss its clinical management according to research-based evidence and medical practice. […] No effective and approved human vaccine against giardiasis is available, and pharmacotherapy is the only available option to treat giardiasis. […] A Cochrane review in 2012 identified a total of only 19 randomized controlled trials (RCTs) comparing metronidazole (MTZ) administered for 510 days with any of the following drugs: MTZ (single dose), tinidazole, albendazole (ABZ), mebendazole, and nitazoxanide.

• #79

  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. A combination of a 5-nitroimidazole and albendazole or mebendazole, and quinacrine as last option, are rational choices in nitroimidazole refractory infections.

• #80 Companion Animal Parasite Council | Giardia

  https://capcvet.org/guidelines/giardia/

  Treatment failures may result from: reinfection, inadequate drug levels, immunosuppression, drug resistance and Giardia sequestration in the gallbladder or pancreatic ducts. […] The presence of immunosuppression, reinfection, or sequestration can usually be determined in a clinical setting. […] Certain immunosuppressed patients are abnormally susceptible to giardiasis and their infections are often difficult to cure. […] Reinfection is common in endemic regions with high environmental contamination. […] Concomitant with treatment, animals should be bathed with shampoo to remove fecal debris and associated cysts on the last day of treatment. […] Remove feces daily and dispose of fecal material with municipal waste. […] Environmental areas (e.g., soil, grass, standing water) are difficult to decontaminate, but surfaces can be sanitized by steam-cleaning or use of commercially available disinfectants. […] Allow surfaces to dry thoroughly after cleaning. […] Post-treatment fecal examination by zinc sulfate centrifugation may be helpful in evaluating the success of therapy.

• #81 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.

• #82 How to Treat Giardia During Pregnancy | American Pregnancy Association

  https://americanpregnancy.org/healthy-pregnancy/pregnancy-health-wellness/treat-giardia-pregnancy/

  How to Treat Giardia During Pregnancy […] Giardia lamblia is a parasite found in soil, food, human or animal waste, and untreated water in developed countries. It is best to prevent contraction of Giardia during pregnancy in the first place. Make sure to boil or filter all untreated water, such as a stream or well water, before you drink it. […] Some people notice their symptoms disappear without any medical intervention. For those whose symptoms persist, there seem to be no known natural remedies for giardiasis. […] It is likely your doctor will delay treatment until after your baby is born. Many of the drugs used to treat giardiasis are not safe to take during pregnancy. […] During pregnancy, your doctor may advise that you limit treatment to treating the symptoms associated with your infection. […] If your Giardiasis is severe, your doctor may prescribe paromomycin. Alternatively, your doctor may prescribe metronidazole. […] This medicine is safe to take throughout pregnancy. Once the disease becomes mild, your doctor may choose to put off treatment until after your baby is born or if you are taking metronidazole, after the first trimester.

• #83 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

  Giardiasis is a common parasitic infection that can cause diarrhea in dogs. It is caused by an intestinal parasite called Giardia, which can be found in feces-contaminated soil, food and water. […] Successful treatment relies on effective anti-parasitic medications, cleaning and managing the surrounding environment both indoors and outdoors. […] The goal of treatment is to resolve diarrhea and other clinical signs. Dogs without symptoms may not require treatment. […] Fenbendazole is a common deworming medication used to treat Giardia. […] Another treatment option is an antibiotic called metronidazole. […] Your veterinarian may also use the two medications in combination. […] Your veterinarian may prescribe a diet that supports digestive health to help resolve diarrhea. […] Dogs should be fully bathed on the last day of treatment to remove fecal material and any remaining Giardia cysts in the dogs fur.

• #84 Companion Animal Parasite Council | Giardia

  https://capcvet.org/guidelines/giardia/

  Treatment failures may result from: reinfection, inadequate drug levels, immunosuppression, drug resistance and Giardia sequestration in the gallbladder or pancreatic ducts. […] The presence of immunosuppression, reinfection, or sequestration can usually be determined in a clinical setting. […] Certain immunosuppressed patients are abnormally susceptible to giardiasis and their infections are often difficult to cure. […] Reinfection is common in endemic regions with high environmental contamination. […] Concomitant with treatment, animals should be bathed with shampoo to remove fecal debris and associated cysts on the last day of treatment. […] Remove feces daily and dispose of fecal material with municipal waste. […] Environmental areas (e.g., soil, grass, standing water) are difficult to decontaminate, but surfaces can be sanitized by steam-cleaning or use of commercially available disinfectants. […] Allow surfaces to dry thoroughly after cleaning. […] Post-treatment fecal examination by zinc sulfate centrifugation may be helpful in evaluating the success of therapy.

• #85 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.

• #86 Companion Animal Parasite Council | Giardia

  https://capcvet.org/guidelines/giardia/

  Treatment failures may result from: reinfection, inadequate drug levels, immunosuppression, drug resistance and Giardia sequestration in the gallbladder or pancreatic ducts. […] The presence of immunosuppression, reinfection, or sequestration can usually be determined in a clinical setting. […] Certain immunosuppressed patients are abnormally susceptible to giardiasis and their infections are often difficult to cure. […] Reinfection is common in endemic regions with high environmental contamination. […] Concomitant with treatment, animals should be bathed with shampoo to remove fecal debris and associated cysts on the last day of treatment. […] Remove feces daily and dispose of fecal material with municipal waste. […] Environmental areas (e.g., soil, grass, standing water) are difficult to decontaminate, but surfaces can be sanitized by steam-cleaning or use of commercially available disinfectants. […] Allow surfaces to dry thoroughly after cleaning. […] Post-treatment fecal examination by zinc sulfate centrifugation may be helpful in evaluating the success of therapy.

• #87 Giardiasis Treatment & Management: Approach Considerations

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

  Generally, treatment is not needed for asymptomatic persons who excrete the organism, except to prevent household transmission and to permit adequate treatment in individuals with possible Giardia intestinalis-associated antibiotic malabsorption who require oral antibiotic treatment for other infections. 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. […] Ensure that close contacts of the patient are also examined for giardiasis and treated if infected. Severely dehydrated or malnourished patients should be admitted for further care. […] No consistent recommendations exist for the treatment of pregnant patients because of the potential adverse effects of anti-Giardia agents on the fetus. If treatment is necessary, paromomycin is an effective treatment with poor systemic absorption. Documenting the continued presence of Giardia in patients who appear unresponsive to treatment is important.

• #88 GUIDELINE for Giardiasis — ABCD cats & vets

  https://www.abcdcatsvets.org/guideline-for-giardiasis/

  Fenbendazole or metronidazole are regarded as the treatments of choice. Due to potential appearance of bacterial and parasitic resistance, it is not recommended to treat asymptomatic Giardia-positive cats. […] The standard treatment of Giardia infection has generally been an imidazole, usually fenbendazole given at 50 mg/kg/day for 5-7 days. Fenbendazole may be used in pregnant queens. Metronidazole is an alternative, and the original recommendation was to use it at a dosage of 50 mg/kg/day for five days but should not be used in pregnant queens. This dosage carries an increased risk of side effects central nervous toxicity causing weakness, ataxia, disorientation and seizures. It has been suggested that treatment during 7 days with a daily dosage of 25 mg/kg is effective, which is unlikely to induce side effects. In some difficult cases implying many infected cats, a second treatment may be necessary and, in that case, combination of fenbendazole and metronidazole may be effective. However, it has been suggested that a second-round treatment with fenbendazole may potentiate the appearance of E. coli antibiotic resistance.

• #89 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. These regimens are generally less efficacious, particularly if only one dose of metronidazole is given. […] The most effective agents for therapy of giardiasis are single doses of tinidazole or ornidazole, 5 to 7 days of quinacrine, and 5 to 7 days of metronidazole. […] The treatment of choice in the United States for both adults and children is metronidazole. A standard course of 5 to 7 days should effectively treat 90% or more of infected individuals. […] If resistance or relapse has occurred, treatment with a drug of a different class or with a combination of a nitroimidazole and quinacrine for at least 2 weeks should eradicate infection.

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

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

  Even after parasitologic cure, patients may experience lactose intolerance, irritable bowel syndrome, or fatigue that last for weeks to months. […] Guidelines for managing recurrent giardiasis infections and treatment failures are available. […] For symptomatic patients, use tinidazole, metronidazole, secnidazole, or nitazoxanide.

• #91 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. […] Supportive care with hydration, correction of electrolyte abnormalities, and nutritional supplementation should be provided. […] 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.

• #92 What’s the most effective treatment for giardiasis? | MDedge

  https://mdedge.com/jfponline/article/63098/infectious-diseases/whats-most-effective-treatment-giardiasis

  A single 2-g dose of tinidazole is the best treatment (strength of recommendation [SOR]: A, based on meta-analysis). Other drugs, such as nitazoxanide, metronidazole, mebendazole, and albendazole, can also be used (SOR: A, based on randomized controlled trial [RCT] of patient-oriented outcomes), but tinidazole has a higher clinical cure rate than these drugs. […] Tinidazole is the treatment of choice. […] The review found that a single dose of tinidazole had a higher clinical cure rate than other therapies such as metronidazole (odds ratio [OR]=5.33; 95% confidence interval [CI], 2.66-10.67) along with a comparable side-effect profile. These findings favor tinidazole as the treatment of choice for symptomatic giardiasis.

• #93 What’s the most effective treatment for giardiasis? | MDedge

  https://blogs.the-hospitalist.org/content/whats-most-effective-treatment-giardiasis

  A single 2-g dose of tinidazole is the best treatment (strength of recommendation [SOR]: A, based on meta-analysis). Other drugs, such as nitazoxanide, metronidazole, mebendazole, and albendazole, can also be used (SOR: A, based on randomized controlled trial [RCT] of patient-oriented outcomes), but tinidazole has a higher clinical cure rate than these drugs. It also has a comparable side-effect profile and requires only 1 dose. […] As this review points out, all the available treatments for giardiasis are effective. […] Tinidazole is the treatment of choice. […] The review found that a single dose of tinidazole had a higher clinical cure rate than other therapies such as metronidazole (odds ratio [OR]=5.33; 95% confidence interval [CI], 2.66-10.67) along with a comparable side-effect profile. These findings favor tinidazole as the treatment of choice for symptomatic giardiasis.

• #94 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. These regimens are generally less efficacious, particularly if only one dose of metronidazole is given. […] The most effective agents for therapy of giardiasis are single doses of tinidazole or ornidazole, 5 to 7 days of quinacrine, and 5 to 7 days of metronidazole. […] The treatment of choice in the United States for both adults and children is metronidazole. A standard course of 5 to 7 days should effectively treat 90% or more of infected individuals. […] If resistance or relapse has occurred, treatment with a drug of a different class or with a combination of a nitroimidazole and quinacrine for at least 2 weeks should eradicate infection.

• #95 Giardiasis – StatPearls – NCBI Bookshelf

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

  Alternative treatment regimens for giardiasis include tinidazole, nitazoxanide, mebendazole, albendazole, and paromomycin. Paromomycin, which has poor systemic absorption, could be considered for a pregnant patient during her first trimester. […] Conflicting data exists regarding the most effective treatment for giardiasis. A systematic review found that albendazole may be as effective as metronidazole with fewer side effects. If patients experience persistent symptoms despite therapy, a medication from another class should be used. […] 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 G intestinalis who require oral antibiotics for other infections. Close contacts of the infected individual for giardiasis should be assessed and treated if infected.

• #96 Giardiasis – Wikipedia

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

  Both medications need a five to ten-day-long course; albendazole is taken once a day, while metronidazole needs to be taken three times a day. […] 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.

• #97 Giardiasis Treatment & Management: Approach Considerations

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

  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.

• #98 Giardiasis – StatPearls – NCBI Bookshelf

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

  Most patients presenting with giardiasis are nontoxic and may necessitate only oral rehydration for initial fluid resuscitation. In severe cases, intravenous (IV) fluids might be necessary. Proper fluid and electrolyte management is crucial, particularly in large-volume diarrheal losses. […] 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. Moreover, an escalating incidence of nitroimidazole-refractory infection has been reported, especially among travelers from India and other Asian countries. Determining an optimal treatment strategy for such cases of giardiasis remains an ongoing challenge.

• #99 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. […] Supportive care with hydration, correction of electrolyte abnormalities, and nutritional supplementation should be provided. […] 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.

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

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

  Even after parasitologic cure, patients may experience lactose intolerance, irritable bowel syndrome, or fatigue that last for weeks to months. […] Guidelines for managing recurrent giardiasis infections and treatment failures are available. […] For symptomatic patients, use tinidazole, metronidazole, secnidazole, or nitazoxanide.

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