How is treatment-resistant giardiasis managed?

Updated: Oct 01, 2018
  • Author: Hisham Nazer, MBBCh, FRCP, DTM&H; Chief Editor: Burt Cagir, MD, FACS  more...
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Answer

Documenting the continued presence of Giardia in patients who appear unresponsive to treatment is important. A significant number of patients develop post-Giardia lactose intolerance and present with symptoms consistent with persistent infection. These patients usually improve with time and with the institution of a lactose-free diet.

If Giardia is found in the patient, a careful history should indicate whether this is a reinfection or a treatment failure. A second course of the same drug, for a longer period or a higher dose, should be effective in reinfections, whereas the use of an alternative drug should be effective in true treatment failures. A combination therapy may have to be implemented in certain cases of treatment failure.

Patients who fail repeated courses of treatment should be evaluated for hypogammaglobulinemia and may require combination therapy or chronic suppressive therapy.


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