Efficacy of Various Drugs for Treatment of Giardiasis

Levi, Guido Carlos; Avila, Christian; Neto, Vicente Amato

doi:10.4269/ajtmh.1977.26.564

Cited by 51 publications

(13 citation statements)

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“…Although its efficacy has generally been considered to be slightly lower than those of metronidazole and quinacrine, curative rates between 80 and 96% have been reported for 7-to 10-day courses (Table 1) (20,52,91,151,178,191,201,255). It is when the drug is given for only 5 days that efficacy falls off considerably (151,178). It is given as four doses per day in both adults (100 mg per dose) and children (1.5 mg/kg) ( Table 2).…”

Section: Classes Of Agents and Clinical Propertiesmentioning

confidence: 99%

“…One dose of tinidazole (Fasigyn) was successfully used in 1971 in a group of Swedish students who acquired giardiasis during a visit to Russia (11). This single, 2-g dose (or equivalent in children) has consistently proven to have a clinical efficacy of 80 to 100% with a median efficacy of 92% (Table 1) (16,126,130,131,146,151,193,222,229,261 (93,130,229,261). There is also improved compliance with this dosing schedule.…”

Section: Classes Of Agents and Clinical Propertiesmentioning

confidence: 99%

“…Clinical trials have employed dosing two and three times daily (usually 250 mg/dose) for 5 to 10 days and shortcourse (1 to 3 days), daily single-dose therapy (2.0 or 2.4 g/ dose) (261). In the 5-to 10-day schedules the efficacy ranges from 60 to 100% in adult and pediatric patients, with a median efficacy in both groups of 92% (Table 1) (20,49,68,91,92,100,127,132,135,150,151,191,201,202,232,256). In general, this schedule is well tolerated, with most side effects involving gastrointestinal upset and metallic taste ( Table 2).…”

Section: Classes Of Agents and Clinical Propertiesmentioning

confidence: 99%

“…Nausea occurs in 5 to 15% of patients given standard multiday courses (135,151). In addition, pancreatitis, central nervous system toxicity at high doses (144,212), and transient, reversible neutropenia have been attributed to metronidazole (147).…”

Section: Classes Of Agents and Clinical Propertiesmentioning

confidence: 99%

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Treatment of Giardiasis

2001

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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. Quinacrine, which is no longer produced in the United States, has excellent efficacy but may be poorly tolerated, especially in children. Furazolidone is an effective alternative but must be administered four times a day for 7 to 10 days. Paromomycin may be used during early pregnancy, because it is not systematically absorbed, but it is not always effective. Patients who have resistant infection can usually be cured by a prolonged course of treatment with a combination of a nitroimidazole with quinacrine

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Section: Classes Of Agents and Clinical Propertiesmentioning

confidence: 99%

Section: Classes Of Agents and Clinical Propertiesmentioning

confidence: 99%

Section: Classes Of Agents and Clinical Propertiesmentioning

confidence: 99%

Section: Classes Of Agents and Clinical Propertiesmentioning

confidence: 99%

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Treatment of Giardiasis

2001

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“…Furazolidone is widely used in Belgium because it has fewer side effects than the imidazoles. Whether the higher failure rate in the treatment of giardiasis with this drug (1,8,9,13) is related to the higher MIC values found in this study for VOL. 28, 1985 on May 9, 2018 by guest http://aac.asm.org/ Downloaded from ANTIMICROB.…”

Section: Discussionmentioning

confidence: 83%

In vitro susceptibilities of 25 Giardia lamblia isolates of human origin to six commonly used antiprotozoal agents

Gordts¹,

Hemelhof²,

Asselman³

et al. 1985

Antimicrob Agents Chemother

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The role drug resistance plays in the occurrence of chronic and recurrent giardiasis has not been established. Extensive data on the susceptibility to antimicrobial agents of living Giardia spp. trophozoites from human origin are lacking. We have determined with a macrodilution method in semisolid medium the in vitro susceptibility of 25 Giardia lamblia isolates, all obtained by routine cultivation of the duodenal fluid of children to six commonly used antiprotozoal drugs. The results showed tinidazole to be the most active drug (all isolates have MICs of .0.5 ,ug/ml). Metronidazole was equally active on all but one isolate, for which an MIC between 0.5 and 1 ,ig/ml was found. Furazolidone was the most active nonimidazole compound tested. More than 50% of the isolates were very susceptible to paromomycin, pyrimethamine, and chloroquine. Two of the strains presented an MIC for paromomycin higher than 10 ,Lg/ml, and six strains needed more than 50 ,ug of pyrimethamine per ml to be inhibited. Decreased susceptibility of several of the isolates to different agents appears to be linked.Although susceptibility testing is not the principal problem in Giardia spp. research, it is not known whether drug resistance or drug ineffectiveness plays a role in chronic and recurrent giardiasis. This is mainly due to the fact that no easy technique was available for in vitro cultivation of the microorganism.Earlier described studies on the susceptibility of Giardia spp. to antimicrobial agents were technically very instructive (2, 4, 6, 11), but interpretation of the data was difficult; the number of strains tested was low (2, 4, 6, 11), and the isolates were mostly not of human origin (4, 6, 11). Moreover, the organisms were often maintained for a long time in axenic cultures before testing. This may have caused changes in important factors like generation time.Recently, we developed a technique enabling the routine cultivation of Giardia lamblia trophozoites from human duodenal aspirates (5). By determining systematically the in vitro susceptibility of these isolates with a macrodilution method in semisolid medium (4) (3,5) and dispensed in 16-mi screw-capped glass tubes. Once the cultures were fully grown, the tubes were placed in ice water for 5 min to detach the microorganisms from the glass, centrifuged, and suspended in 2 ml of phosphate-buffered saline. A trophozoit count was performed in a FuchsRosenthal chamber, and the suspension was adjusted to a final concentration of 3 x 106 trophozoites per ml.Antimicrobial agents.The following antiprotozoal drugs were tested: tinidazole (Fasigyn; Roerig), metronidazole (Flagyl; Rhone-Poulenc), chloroquine (Nivaquine; RhonePoulenc), pyrimethamine (Daraprim; Wellcome Research Laboratories), furazolidone (Furoxone; Norwich), and paromomycin (Hematin; Parke, Davis & Co.). Fresh stock solutions of 2,000 ,ug/ml were prepared by dissolving pure substance of each test drug in 3 ml of distilled water (for chloroquine and paromomycin) or dimethyl formamide (for tinidazole, metronidazole, py...

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Five v Ten Days' Therapy With Furazolidone for Giardiasis

Murphy

Nelson

1983

Arch Pediatr Adolesc Med

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Efficacy of Various Drugs for Treatment of Giardiasis

Cited by 51 publications

References 0 publications

Treatment of Giardiasis

Treatment of Giardiasis

In vitro susceptibilities of 25 Giardia lamblia isolates of human origin to six commonly used antiprotozoal agents

Five v Ten Days' Therapy With Furazolidone for Giardiasis

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