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Published on: August 22, 2012
Intestinal giardiasis in children: Five years' experience in a reference unit
M F Ara-Montojo1, J Bustamante2, T Sainz3
1Paediatric Tropical and Infectious Diseases, Department of Paediatrics, La Paz University Hospital, Madrid, Spain.
Insights
Giardiasis treatment failure is common in children, particularly those under two. Higher metronidazole doses improve success, and quinacrine is an effective second-line option for persistent giardiasis.
Area of Science:
- Pediatric infectious diseases
- Gastroenterology
- Parasitology
Background:
- Giardiasis is a common childhood infection, often with mild symptoms.
- Metronidazole is the standard first-line treatment, but its efficacy can be limited.
- Treatment failures necessitate exploring alternative strategies and identifying risk factors.
Purpose of the Study:
- To identify risk factors for treatment failure in pediatric giardiasis.
- To evaluate the safety and effectiveness of alternative treatment strategies.
- To analyze treatment outcomes in a cohort of children with giardiasis.
Main Methods:
- Retrospective observational study of children diagnosed with giardiasis (2014-2019).
- Diagnosis confirmed via microscopy, antigen detection, and/or PCR stool analysis.
- Treatment failure defined as persistent Giardia detection 4 weeks post-therapy.
Main Results:
- First-line metronidazole treatment failure occurred in 20% of cases; a higher dose reduced failure to 8.3%.
- Children under 2 years old had a significantly higher risk of treatment failure (OR 3.49).
- Quinacrine demonstrated 100% effectiveness in 10 patients treated as a second-line option.
Conclusions:
- Treatment failure in pediatric giardiasis is frequent, especially in children younger than 2 years.
- Quinacrine shows promise as an effective second-line treatment for refractory giardiasis.
- Confirmation of parasite eradication after treatment is recommended.
Background:
Giardiasis is highly prevalent in children and is often mildly symptomatic. First-line treatment is metronidazole, but treatment failure is not uncommon. We describe a paediatric series, to identify risk factors for treatment failure and to analyse the safety and effectiveness of other treatment strategies.
Methods:
Retrospective observational study, including children diagnosed with giardiasis from 2014 to 2019. Diagnosis was based on direct visualisation by microscopy after concentration using an alcohol-based fixative, antigen detection and/or DNA detection by polymerase chain reaction in stool. Treatment failure was considered when GI was detected 4 weeks after treatment.
Results:
A total of 120 patients were included, 71.6% internationally adopted, median age 4.2 (2.3-7.3) years. Only 50% presented with symptoms, mainly diarrhoea (35%) and abdominal pain (14.1%); co-parasitism was frequent (45%). First-line treatment failure after a standard dose of metronidazole was 20%, lowering to 8.3% when a higher dose was administered (p < 0.001). Quinacrine was administered in 10 patients, with 100% effectiveness. Children <2 years were at higher risk of treatment failure (OR 3.49; 95% CI 1.06-11.53; p = 0.040).
Conclusions:
In children with giardiasis, treatment failure is frequent, especially before 2 years of age. Quinacrine can be considered as a second-line treatment. After treatment, eradication should be confirmed.
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