Giardia, flagyl resistance and quinacrine

joost zaat jzaat at
Fri Jul 5 23:00:06 EST 1996

colin_semple at (colin semple) wrote:

>A couple of cases of giardiasis have recently given us reason to suspect 
>flagyl resistance.   Previously most suspected resistance we could 
>attribute to non-compliance or reinfection.  Our problem is that quinacrine is 
>getting harder and harder to get.   Here in Canada, Tinidazole is not an 
>option.  Any other alternatives?  Any suggestions? 

Metronidazol resistance exists. Titia Kortbeek (RIVM, the Netherlands)
had cultured Giardia and was been able to proven that it was possible
to make every strain resistant against metronidazole.

We have recently done a Cochrane systematic review on treatment of
Giardiasis; 30 real randomized clinical trials found. The
methodological quality of most trials is rather poor, but there is a
trend for short courses being equal or better than standard

Albendazoleis probable a good alternative, but there are only a few
trials (Hall 1993) with probable a to low dose.

Results are published in Zaat JOM, Mank ThG, Assendelft WJJ. Treatment
of giardiasis. in Cheng C, Garner P, Gelband H, Salinas R (eds)
Parasitic Diseases Module of The Cochrane Database of Systematic
reviews, 1996. Avalible in the Cochrane libary from BMJ Publishing

If you want further information, please contact me.

Joost Zaat, general practitioner
EMGO Institute, Vrije Universiteit, Amsterdam, the Netherlands 

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