Comparison of Mebendazole with Metronidazole and Furazolidone in the Treatment of Giardiasis in Children

Abstract

and Furazolidone in the Treatment of Giardiasis in Children. 1995; 15(6): 655-656 Giardia lamblia is a flagellated protozoan that has adapted to being a parasite in the upper gut of a person. As a worldwide health problem, the carriage rate of giardiasis ranges between 1% and 7% in developed countries and 5% to 50% in developing countries.1 In addition to standard therapies with metronidazole and furazolidone, mebendazole has been suggested as a new agent in this field. 2 We have compared the efficacy of these drugs in childhood giardiasis. Forty-five symptomatic giardiasis cases (ages 34 months to 16 years) were selected from the outpatient department of a university hospital. The children had the following complaints for 45 to 120 days (mean 86): abdominal cramps (82%), vomiting (27%), greasy stools (24%), flatulence (18%), weight loss (18%) and anorexia (67%). With the medical histories and laboratory examinations, all of the children were accepted as immunocompetent. Stool specimens were examined within one hour after being passed for both cysts and trophozoites of Giardia lamblia.3 G. lamblia cysts were seen in all cases and trophozoites in only 14 cases. The patients, none of whom had any treatment for giardiasis, were divided into three groups (15 children in each group) and chosen randomly to receive mebendazole (200 mg three times daily for 10 days), 2,4,5 metronidazole (5 mg/kg three times daily for 10 days) or furazolidone (2 mg/kg four times daily for 10 days). 1,6 In addition to clinical monitoring, three fecal specimens were re-examined for seven to 10 days after the treatment by investigators who were unaware of the drugs used or the results of the treatment. The mean ages were 7.7+0.9 years in the metronidazole group, 7.8±0.8 years in the furazolidone group and 9.3+0.9 years in the mebendazole group. Reexamination of stools showed the presence of giardial cysts in one patient from the metronidazole group, in three from the furazolidone group and in four from the mebendazole group. Those patients who had not responded to mebendazole or furazolidone therapies were treated with metronidazole successfully and the metronidazole group was a second cure with the same therapy. Mild nausea and vomiting were seen in two from the metronidazole group, in two from the furazolidone group and in one from the mebendazole group. In addition, two patients from the metronidazole group developed mild headache.There is general agreement that all children with symptomatic giardiasis should receive chemotherapy with any one of the three available drugs: metronidazole, furazolidone and quinacrine.

Treatment of Giardiasis

“…Al-Waili reported over 90% efficacy in two studies in children (8,9). However, other studies in both pediatric and adult populations have not shown equal success but instead have shown effectiveness in 80% (211) and in 60% or less (39,92,132; L. di Martino, A. Nocerino, and M. Pettoello Mantovani, Letter, Trans. R. Soc.…”

“…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).…”

“…Children have been included in many of the trials of both long-and short-course therapy, with outcomes similar to those in adults and 80 to 100% efficacy (median, 94%) in the 5-to 10-day regimens (91,100,132,135,186,201,232; A. RastegarLari and A. Salek-Moghaddam, Letter, J. Trop. Pediatr.…”