Giardiasis: A pharmacotherapy review

Jefe del departamento de Microbiología y Parasitología, Hospital Pediatrico Universitario Pedro Borrás, Ciudad de La Habana, CP, Cuba.
Expert Opinion on Pharmacotherapy (Impact Factor: 3.53). 09/2007; 8(12):1885-902. DOI: 10.1517/14656566.8.12.1885
Source: PubMed


Giardia lamblia, the cause of human giardiasis, is among the most common intestinal protozoa worldwide. Human infection may range from asymptomatic shedding of giardial cysts to symptomatic giardiasis, being responsible for abdominal cramps, nausea, acute or chronic diarrhoea, with malabsorption and failure of children to thrive. At present, treatment options include the nitroimidazoles derivatives; especially metronidazole, which has been the mainstay of treatment for decades and is still widely used. The increasing number of reports of refractory cases with this group of drugs and other antigiardial agents, has raised concern and led to a search for other compounds, some of which have arisen due to the introduction of drugs initially addressed to other diseases. The present article examines some of the most important points of antigiardial pharmacotherapy available at present and the future prospects of development of new agents.

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Available from: Angel A Escobedo, Mar 29, 2014
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    • "frontiersin . org 5 October 2015 Escobedo and Cimerman , 2007 "
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    ABSTRACT: Diarrhea is the manifestation of gastrointestinal infection and is one of the major causes of mortality and morbidity specifically among the children of less than 5 years age worldwide. Moreover, in recent years there has been a rise in the number of reports of intestinal infections continuously in the industrialized world. These are largely related to waterborne and food borne outbreaks. These occur by the pathogenesis of both prokaryotic and eukaryotic organisms like bacteria and parasites. The parasitic intestinal infection has remained mostly unexplored and under assessed in terms of therapeutic development. The lack of new drugs and the risk of resistance have led us to carry out this review on drug development for parasitic diarrheal diseases. The major focus has been depicted on commercially available drugs, currently synthesized active heterocyclic compounds and unique drug targets, that are vital for the existence and growth of the parasites and can be further exploited for the search of therapeutically active anti-parasitic agents.
    Frontiers in Microbiology 10/2015; 6(6):1183. DOI:10.3389/fmicb.2015.01183 · 3.99 Impact Factor
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    • "Undesirable side-effects, poor patient compliance and " drug resistance " are associated to treatment failures and with contraindications of these drugs for some patients . Other compounds belonging to different pharmacological classes have already been studied in the giardiasis context [23] [24]; one of them is chloroquine (CQ). This paper reviews published data on the use of this drug as a treatment for Giardia infections. "
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    ABSTRACT: The occurrence of treatment failures to first-line treatment for giardiasis, one of the most widespread although neglected parasitic disease, has long been recognised. Nowadays, it starts to represent a great challenge to clinicians, especially in endemic countries. This requires the introduction of new drug interventions, but the development of novel drugs is a time and money consuming effort with most of the compounds never reaching the market. Consequently, alternative strategies are needed, especially for the treatment of giardiasis. Chloroquine (CQ), a synthetic drug developed as antimalarial agent, has been shown to also exert an antigiardial activity. Here, we present a minireview summarizing results on the treatment of human clinical cases with CQ, going through in vitro research, case report, and case series to human clinical trials, highlighting the benefits and mentioning possible adverse effects.
    09/2015; 10(999). DOI:10.2174/1574891X10666150914122118
    • "The reported efficacy is 89% [2]. Single-dose tinidazole has similar efficacy but fewer side effects, and thus better compliance [2]. A study of 170 patients in Madrid between 1989 and 2004 found 5.8% failed a mean of 3 courses of metronidazole [3]. "
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    ABSTRACT: Giardia intestinalis is the commonest gastrointestinal protozoal pathogen worldwide, and causes acute and chronic diarrhoea with malabsorption. First-line treatment is with a nitroimidazole, with a reported efficacy rate of 89%. Failure of treatment can occur in patients with hypogammaglobulinaemia or human immunodeficiency virus (HIV), or be due to nitroimidazole-resistant organisms. There is little evidence to guide the clinical management of nitroimidazole-refractory disease. We performed a retrospective audit of nitroimidazole-refractory giardiasis in returned travellers at the Hospital for Tropical Diseases, London between 2011 and 2013. Seventy-three patients with microscopy-proven or PCR-proven giardiasis in whom nitroimidazole treatment had failed were identified, and their management was investigated. In 2008, nitroimidazole treatment failed in 15.1% of patients. This increased to 20.6% in 2011 and to 40.2% in 2013. Patient demographics remained stable during this period, as did routes of referral. Of patients with giardiasis, 39.0% had travelled to India; this rose to 69.9% in patients with nitroimidazole-refractory disease. Of the patients with refractory disease, 44.6% had HIV serological investigations performed and 36.5% had immunoglobulin levels determined. Patients with refractory disease were treated with various agents, including albendazole, nitazoxanide, and mepacrine, alone or in combination. All 20 patients who received a mepacrine-containing regimen were cured. This data shows a worrying increase in refractory disease, predominantly in travellers from India, which is likely to represent increasing nitroimidazole resistance. Improved tools for the diagnosis of resistant G. intestinalis are urgently needed to establish the true prevalence of nitroimidazole-resistant giardiasis, together with clinical trials to establish the most effective second-line agent for empirical treatment regimens. © 2015 European Society of Clinical Microbiology and Infectious Diseases.
    Clinical Microbiology and Infection 05/2015; 21(8). DOI:10.1016/j.cmi.2015.04.019 · 5.77 Impact Factor
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