Chemotherapy for Giardiasis: Randomized Clinical Trial of Bacitracin, Bacitracin Zinc, and a Combination of Bacitracin Zinc with Neomycin

Andrews, Bernice; Panitescu, Dan; G, Jipa; Vasile-Bugarin, Alexandru C.; Vasiliu, Rhodica P.; Rønnevig, Jørgen

doi:10.4269/ajtmh.1995.52.318

Cited by 22 publications

(14 citation statements)

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“…A clinical trial by Andrews et al used twice-daily dosing over 10 days and compared the effectiveness of 120,000 U of bacitracin zinc, 120,000 U of bacitracin, 120,000 U of neomycin, and 60,000 U of bacitracin zinc in combination with 60,000 U of neomycin (14). Cure rates of 95% for bacitracin zinc, 88% for either bacitracin or the bacitracin zinc-neomycin combination, and 86% for neomycin were demonstrated.…”

Section: Classes Of Agents and Clinical Propertiesmentioning

confidence: 99%

“…The drug has not VOL. 14,2001 TREATMENT OF GIARDIASIS 123 received a Food and Drug Administration indication for giardiasis, and these high doses may have increased side effects. Furazolidone is an effective alternative but requires 7 to 10 days of treatment four times a day, which will probably affect compliance.…”

Section: Recommendationsmentioning

confidence: 99%

“…Passive transfer of antiGiardia immune serum did not facilitate parasite clearance in VOL. 14,2001 TREATMENT OF GIARDIASIS 121 on May 12, 2018 by guest http://cmr.asm.org/ murine giardiasis (76,242). Although patients with common variable immunodeficiency do have symptomatic and prolonged infection with Giardia antiparasitic therapy is required to control their infection (106,216).…”

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: Recommendationsmentioning

confidence: 99%

Section: Classes Of Agents and Clinical Propertiesmentioning

confidence: 99%

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Treatment of Giardiasis

2001

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“…For example, the combination of MTZ and QC has shown the most interesting results, supporting CT in clinical series, but RCTs on its use has not yet been performed. A few as six RCTs on CT have been published so far (Table 2) (Andrews et al, 1995;Cacopardo et al, 1995;Grant et al, 2001;Pengsaa et al, 2002;Pengsaa et al, 2004;Speich et al, 2013). In one trial bacitracin, bacitracin zinc and neomycin alone were compared to a combination of bacitracin zinc/neomycin (Andrews et al, 1995).…”

Section: Randomized Clinical Trialsmentioning

confidence: 99%

“…Andrews et al, 1995 ;Andrews et al, 1994;Gardner and Hill, 2001 PFOR: enzyme pyruvate:ferredoxin oxidoreductase The combination of the two drugs ABZ-NTZ has not got sufficient efficacy; in fact, curiously was less than placebo.…”

Section: -Nitroimidazole Compoundsmentioning

confidence: 99%

Combination therapy in the management of giardiasis: What laboratory and clinical studies tell us, so far

et al. 2016

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Treatment failures in patients suffering from giardiasis is not uncommon feature. The most frequent approach in these cases is to treat these patients with longer repeated courses and/or higher doses of the primary therapy, or using drugs from a different class to avoid potential cross-resistance. However, a higher rate of adverse events may limit this strategy. In this context, combination therapy (CT) is emerging as a valuable option against refractory giardiasis. In the attempt to evaluate the benefits of CT, a number of experimental studies, clinical series, and randomized clinical trials (RCTs), as well as several veterinary studies have been performed, with varying results. Here, we present a critical analysis of the available information regarding CT for the treatment of Giardia infection, as well as the authors' opinion with respect to its use. RCTs of combination therapy are limited and the optimal combinations and administration strategies need yet to be clarified. Analyses of the cost-effectiveness and RCTs of CTs for Giardia infection are required to assess the role of these drugs for the control of giardiasis, mainly in the case of treatment failures linked to suspected drug tolerance are the case. KeywordsGiardia To view all the submission files, including those not included in the PDF, click on the manuscript title on your EVISE Homepage, then click 'Download zip file'. HighlightsTreatment failures are not uncommon in giardiasis.Published studies have shown combination therapy in giardiasis to be safe and effective.Observations encourage the study of combinations of metronidazole with albendazole or quinacrine.Combination therapy could be a useful alternative in the case of treatment failures linked to suspected drug tolerance. Treatment failures in patients suffering from giardiasis are not uncommon feature. The most frequent approach in these cases is to treat these patients with longer repeated courses and/or higher doses of the primary therapy, or using drugs from a different class to avoid potential cross-resistance. However, a higher rate of adverse events may limit this strategy. In this context, combination therapy (CT) is emerging as a valuable option against refractory giardiasis. In the attempt to evaluate the benefits of CT, a number of experimental studies, clinical series, and randomized clinical trials (RCTs), as well as several veterinary studies have been performed, with varying results. Here, we present a critical analysis of the available information regarding CT for the treatment of Giardia infection, as well as the authors' opinion with respect to its use. RCTs of combination therapy are limited and the optimal combinations and administration strategies need yet to be clarified. Analyses of the cost-effectiveness and RCTs of CTs for Giardia infection are required to assess the role of these drugs for the control of giardiasis, mainly in the case of treatment failures linked to suspected drug tolerance are the case.

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