title: Effects of albendazole/metronidazole or tetracycline/folate treatments on persisting symptoms after Giardia infection: a randomized open clinical trial.
abstract: After an epidemic of giardiasis, some patients experienced persisting abdominal symptoms despite becoming Giardia-negative in stool samples after metronidazole treatment. The study aimed to determine if these patients were suffering from treatment refractory, chronic, cryptic giardiasis. The design was a prospective randomized open clinical trial with 1 arm receiving anti-Giardia treatment in the form of albendazole and metronidazole (A/M) for 7 d (n=12) and the other arm receiving tetracycline and folic acid (T/F) for 28 d (n=13). Symptom scores and global improvement were outcome measures. Symptom scores were analysed regarding time and treatment using mixed linear modelling. In both groups total symptom scores improved at the end of treatment; the improvement was significant for the T/F group. Bloating decreased significantly in both groups at the end of treatment. One month after treatment, 3 patients in the T/F group (23.1%) and 1 patient (8.3%) in the A/M group reported global symptom improvement. Symptoms recurred in all of these, and after 1 y total symptom scores were unchanged from baseline in either group. Treatment of post-giardiasis persistent abdominal symptoms with T/F or A/M resulted in only temporary symptom relief, possibly due to the anti-inflammatory effect of both treatments. Cryptic chronic giardiasis was not the explanation for the persistent symptoms.
authors.affiliation: Department of Medicine, Haukeland University Hospital, Bergen, Norway. kurt.hanevik@helse-bergen.no
authors.forename: Kurt
authors.initials: K
authors.lastname: Hanevik
authors.forename: Kristine
authors.initials: K
authors.lastname: Mørch
authors.forename: Geir Egil
authors.initials: GE
authors.lastname: Eide
authors.forename: Nina
authors.initials: N
authors.lastname: Langeland
authors.forename: Trygve
authors.initials: T
authors.lastname: Hausken
mesh_terms: D000328:Adult; D015766:Albendazole / Q000627:therapeutic use*; D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D005243:Feces / Q000469:parasitology; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D005872:Giardia / Q000187:drug effects; D005873:Giardiasis / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013752:Tetracycline / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000981:Antiprotozoal Agents; D008795:Metronidazole; D005492:Folic Acid; D015766:Albendazole; D013752:Tetracycline