Management of chronic Giardia infection

Abstract

Advances in our understanding of chronic giardiasis (CG) may improve our care of patients in this stage of the disease. This review proposes a new concept of CG and highlights the recent advances in our understanding and management of this condition. According to this review, management requires, initially, an accurate diagnosis, which may exclude several conditions that can mimic CG. Optimal treatment requires a tailored approach which includes the recognition of the known modifiable causes of this health condition, assessment of symptoms and potential complications, their treatment utilizing, if necessary, a multidisciplinary team, and an ongoing monitoring for the effect of therapy – weighing the efficacy of individual drugs – all of these together may lead to a successful treatment of CG.

Keywords::

• 5-nitroimidazoles
• albendazole
• chronic giardiasis
• Giardia
• nitazoxanide
• quinacrine
• resistance
• tinidazole
• treatment failure

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Chronic giardiasis (CG) is a form of disease that is not sufficiently studied.

• Continued research about CG will lead to a better understanding of its health impact and improved strategies for countering its detrimental effects.

• It is necessary to improve and simplify sensitive and specific diagnostic tools in evaluating chronic symptoms, especially in developing countries.

• It is critical to search for more effective drugs against CG not responding to treatment with standard drugs.

• It is increasingly necessary to establish susceptibility patterns in Giardia isolates from patients in whom standard antimicrobial therapy has failed. Such resistance monitoring could allow public health authorities to optimize treatment regimens.

• Therapy with combinations of drugs has been poorly investigated so far and studies are urgently needed.