The Results of Giardiasis Treatment Using Giardicidal Drugs and their Combination with Probiotics in Children: A Retrospective Cohort Study

Abstract

Background. Giardiasis in children remains an urgent problem, the significance of which is determined by the endemicity for many countries and regions, outbreaks of sporadic epidemics, polymorphism of clinical symptoms, and insufficient treatment efficacy. Objective. Our aim was to study the results of giardiasis treatment using giardicidal drugs or their combination with probiotics in children. Methods. We analyzed the frequency of Giardia lamblia elimination (the main outcome) as a result of giardiasis treatment (laboratory confirmed) in children aged from 3 months to 18 years who received giardicidal drugs (nifuratel, albendazole) or their combination with probiotics based on Saccharomyces boulardii (probiotic 1) and live freeze-dried lactic acid bacteria Lactobacillus acidophilus (L. gasseri), Bifidobacterium infantis, and Enterococcus faecium (probiotic 2) in outpatient or inpatient settings. Additionally, we registered the duration of the main symptoms of giardiasis (abdominal pain, diarrhea), the prevalence of intestinal dysbiosis and lactase deficiency. The considering period is from January 2015 to September 2017. Results. The results of giardiasis treatment were studied in 4 groups: monotherapy with nifuratel (n = 65) or albendazole (n = 64), a combination of nifuratel + probiotic 1 (n = 67) or albendazole + probiotic 2 (n = 64). The groups were comparable by sex, age, and clinical manifestations of the disease. The elimination of lamblia on the 14–16th day of monotherapy with giardicidal drugs was achieved in 56–60%, when combined with probiotics — in 84% of patients for each combination (df = 3, p < 0.001). Against the background of combination therapy, the disease symptoms (abdominal pain, diarrhea, vomiting) were reversed 1.5 times faster; the number of patients with lactase deficiency and intestinal dysbiosis decreased two and more times, under monotherapy with giardicidal drugs — 1.2 times (df = 3, p < 0.001). Conclusion. Giardiasis treatment in children using combination therapy, including giardicidal drugs and probiotics, is more effective than monotherapy with giardicidal drugs.