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: 3.09). 09/2007; 8(12):1885-902. DOI: 10.1517/14656566.8.12.1885
Source: PubMed

ABSTRACT 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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    • "Fatty to watery diarrhea is a hallmark of acute and chronic giardiasis that in children may result into malabsorption, failure to thrive and deficit in weight gain. Adult asymptomatic carriers are frequently observed (Adam, 2001; Escobedo and Cimerman, 2007). "
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    ABSTRACT: Albendazole (ABZ) is a therapeutic benzimidazole used to treat giardiasis that targets β-tubulin. However, the molecular bases of ABZ resistance in Giardia duodenalis are not understood because β-tubulin in ABZ-resistant clones lacks mutations explaining drug resistance. In previous work we compared ABZ-resistant (1.35, 8, and 250 μM) and ABZ-susceptible clones by proteomic analysis and eight proteins involved in energy metabolism, cytoskeleton dynamics, and antioxidant response were found as differentially expressed among the clones. Since ABZ is converted into sulphoxide (ABZ-SO) and sulphone (ABZ-SOO) metabolites we measured the levels of these metabolites, the antioxidant enzymes and free thiols in the susceptible and resistant clones. Production of reactive oxygen species (ROS) and levels of ABZ-SO/ABZ-SOO induced by ABZ were determined by fluorescein diacetate-based fluorescence and liquid chromatography respectively. The mRNA and protein levels of antioxidant enzymes (NADH oxidase, peroxiredoxin 1a, superoxide dismutase and flavodiiron protein) in these clones were determined by RT-PCR and proteomic analysis. The intracellular sulfhydryl (R-SH) pool was quantified using dinitrobenzoic acid. The results showed that ABZ induced ROS accumulation in the ABZ-susceptible Giardia cultures but not in the resistant ones whilst the accumulation of ABZ-SO and ABZ-SOO was lower in all ABZ-resistant cultures. Consistent with these findings, all the antioxidant enzymes detected and analyzed were upregulated in ABZ-resistant clones. Likewise the R-SH pool increased concomitantly to the degree of ABZ-resistance. These results indicate an association between accumulation of ABZ metabolites and a pro-oxidant effect of ABZ in Giardia-susceptible clones. Furthermore the antioxidant response involving ROS-metabolizing enzymes and intracellular free thiols in ABZ-resistant parasites suggest that this response may contribute to overcome the pro-oxidant cytotoxicity of ABZ.
    Frontiers in Microbiology 04/2015; 6:286. DOI:10.3389/fmicb.2015.00286 · 3.94 Impact Factor
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    • "Furazolidone In-vivo World wide Bassily, et al., 1970; Garg, 1972; Wolfe, 1975; Craft et al., 1981; Lerman and Walker, 1982; Murphy and Nelson, 1983; Dupont and Sullivan, 1986; Quiros-Buelna, 1989; Escobedo and Cimerman, 2007; Albendazole In-vivo Bangladesh, Cuba Hall and Nahar, 1993: Canete et al., 2012 Mebendazole In-vivo Cuba Almirall et al., 2011 Fenbendazole In-vivo Belgium Geurden et al., 2010 Secnidazole In-vivo Cuba Almirall et al., 2011 Paromomycin In-vivo, in-vivo Australia, Egypt, Belgium, USA Boreham et al., 1985; Gordts et al., 1985; Hill, 1993); Awadalla et al., 1995 Ethanobotanical agents (Geranium nivem, Pippali rasayana and Piper longum) "
    Article: Giardiasis
    Rvas Giardiasis · A Raza · Z Iqbal · G Muhammad · K Hanif · M A Khan
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    ABSTRACT: Giardiasis is one of the major gastrointestinal parasitic scourges of all the mammals. Giardia is one of the most prevalent gastrointestinal zoonotic protozoan and millions of people are suffering from giardiasis throughout the world. Giardia lamblia is the most prevalent species and responsible for disease production in all mammals. It is associated with poor hygienic conditions and transmitted through fecal-oral route via contaminated food and water. A variety of drugs are reported to have considerable efficacy against Giardia infections like metronidazole, furazolidone, albendazole, mebendazole and some ethanobotanical agents. Good hygienic and sanitation measures are advised to reduce the contamination of the environment that helps to control the giardiasis. The purpose of this article is to comprehensively review the epidemiology, disease pathology and treatment of this zoonotic disease. © 2013 Friends Science Publishers
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    • "Five nitroimidazole compounds are considered to be the first-line regular therapy for this infectious disease. However, whilst their therapeutic benefits are generally accepted, treatment failures are often reported [2] [3], and that is why a variety of new approaches to the treatment of giardiasis have been entering into clinical practice [4]. Evidence from uncontrolled case series and clinical trials in paediatric patients suggests that mebendazole (MBZ) might have a role in the treatment in this parasitosis and that its therapeutic effect is achieved without an accompanying increase of side effects [5] [6] [7] [8]. "
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    ABSTRACT: To compare the efficacy and safety of mebendazole and secnidazole in the treatment of giardiasis in adult patients, a single-centre, parallel group, open-label, randomized non-inferiority trial was carried out. One-hundred and 26 participants who had symptomatic Giardia mono-infection took part in the study. Direct wet mount and/or Ritchie concentration techniques and physical examinations were conducted at the time of enrolment and at the follow-up visit. The primary outcome measure was parasitological cure, performed at 3, 5, 10 days post-treatment. Negative faecal specimens for Giardia were ensured by the same parasitological techniques. At follow up (day 10) the parasitological cure rate for the per protocol populations was 88.7% (55/62) for MBZ and 91.8% (56/61) for SNZ. For the intention to treat populations the cure rate at the end of treatment was 85.9% (55/64) for MBZ and 90.3% (56/62) for SNZ. Both analyzes showed there was not significant statistical difference between MBZ and SNZ treatment efficacy. Both drugs were well tolerated, only mild, transient and self-limited side effects were reported and did not require discontinuation of treatment. A 3-day course of mebendazole seems to be as efficacious and safe for treatment of giardiasis as a single dose of secnidazole in adults.
    Journal of Parasitology Research 11/2011; 2011:636857. DOI:10.1155/2011/636857
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