Treatment of giardiasis

Inside each person there is a huge number of different microorganisms. Giardia are dangerous protozoan parasites that negatively affect health and well-being. Infection with giardiasis almost always occurs through the ingestion of giardia cysts through the mouth. At the same time, a person who is sick with this disease excretes millions of such parasites of microscopic size with his feces.

Cysts after returning back to the environment are perfectly preserved for quite a long time. A person becomes ill with giardiasis if he eats unwashed vegetables and fruits, bathes in untested open water, drinks fresh dirty water and does not follow the basic rules of personal hygiene. Animals can also be carriers of this disease.

Giardia settle in the human small intestine. Often they live in the duodenum or bile ducts of the liver. Parasites have special suckers with which they attach to mucous membranes.

Any signs of the presence of giardiasis in the body (cysts in the patient’s feces, antigens to them in the blood, vegetative forms) are indications for the start of therapy for this disease. It is started even in the absence of negative symptoms. Treatment of giardiasis is carried out only by a specialist, since the drugs used have high toxicity and a large number of side effects.

Reasons for the lack of a single treatment regimen for giardiasis:

• Unclear criteria for recovery and symptoms of re-infection;

• Lack of uniform standards of treatment;

• A large number of side effects in the drugs used;

• Frequent occurrence of reinvasion in patients with unstable immunity;

• The emergence of varieties of Giardia resistant to the action of common drugs (Furazolidone, Metronidazole);

• Accession of concomitant bacterial and fungal infections (Helicobacter pylori, fungi of the genus Candida), the need for additional treatment.

The combination of giardiasis with diseases of the digestive tract does not allow the destruction of parasites without prior preparation. Massive eradication will inevitably lead to an exacerbation of the disease and increased intoxication.

3 stages of giardiasis treatment:

1. The preparatory stage is carried out in order to normalize the functioning of the digestive system and reduce the number of lamblia.

2. The stage of destruction of parasites is carried out by two courses of different drugs with a break between them of one week.

3. The final stage is carried out in order to normalize immunity, restore the activity of the digestive system, and eliminate dysbacteriosis.

The absence of complications from the gastrointestinal tract allows you to skip the preparatory stage and immediately proceed to the second stage of the destruction of parasites.

Stage number 1 treatment of giardiasis – preparation

The duration of this period directly depends on the degree of intoxication and the severity of the pathologies of the digestive tract – it lasts from several days to 3-4 weeks.

Diet

Treatment of giardiasis begins with adjusting the diet, reducing the amount of carbohydrates and increasing the proportion of proteins.

Diet for giardiasis:

• Restriction of carbohydrates, as they are a breeding ground for parasites. The restriction is also imposed on lactose contained in dairy products.

• Introduction to the menu of a large amount of protein that inhibits the growth of Giardia.

• Creating an acidic environment to inhibit the growth of parasites, the use of fermented milk products, berries and juices.

• Frequent fractional meals (up to 6 times a day) without long intervals between meals, such a system contributes to increased bile secretion, which negatively affects Giardia.

• The introduction of a large amount of dietary fiber in the diet (use up to 20-30 g of bran per day).

The best diet option is Pevzner’s diet No. 5. It is intended for patients with pathologies of the liver and gallbladder. For patients with giardiasis, the diet is somewhat changed, reducing the amount of foods with lactose and carbohydrates.

Products recommended for consumption:

• Fruits and vegetables, fresh herbs;

• Whole grain bread, bran bread;

• Fermented milk products (ryazhenka, kefir, sour cream, yogurt, acidophilus drink, ayran);

• Porridges on the water from buckwheat, rice, oatmeal;

• Low-fat soups, lean meat and fish dishes;

• Marmalade, honey and marshmallows are allowed.

Prohibited products:

• Fatty meat and fish;

• Strong meat broths;

• Animal fats, lard, margarine;

• Bean dishes;

• Eggs (no more than 1 pc. in various dishes);

• Seasonings and smoked meats;

• Confectionery, ice cream, carbonated drinks;

• Mushrooms.

Preparations used at the preparatory stage

The most commonly used drugs from the group of enterosorbents:

• Smecta is a preparation of natural origin, consisting of magnesium and aluminum salts. It is designed to bind and remove gases and toxins from the digestive tract, excess bile and hydrochloric acids. It is a cytoprotector, as it effectively protects the mucous membrane of the digestive tract from the negative effects of various factors. Smecta promotes the growth and development of lactobacilli, is used to prevent dysbacteriosis. The drug does not act on pathogens of parasitic infection, but reduces their concentration in the intestine. This drug has no contraindications, it is used to treat newborns, as well as pregnant and lactating women.

• Enterosgel is a drug that is a molecular sponge for absorbing toxins: alcohol, salts of heavy metals, allergens and antigens. The tool is used to improve the condition of the digestive tract and its regeneration, renew the mucous membrane, increase local immunity. Enterosgel is safe, has no side effects, and may slightly reduce the effectiveness of concurrent medications. Not recommended for infants, pregnant and lactating women in the form of the drug with added sugar.

For constipation, a safe laxative such as Lactulose (Duphalac, Normaze) is prescribed, which has no contraindications for pregnant and lactating women.

With disorders of bile secretion, the gastroenterologist specifies the nature of the pathology. For this, an ultrasound of the gallbladder is performed.

Doctor’s recommendations for the treatment of giardiasis against the background of gastrointestinal dysfunctions

Treatment of dysfunction of the gallbladder, characterized by pain in the right hypochondrium:

• Inclusion in the diet of vegetable fats (up to 80 mg / day);

• Treatment with prokinetics: Domperidone as an antiemetic 5-10 mg half an hour before meals;

• Reception of cholecystokinetics: solutions of xylitol, sorbitol or magnesium sulfate, 2-3 tbsp. l. 2-3 rubles / day.

Treatment of dysfunction of the sphincter that regulates the flow of bile and pancreatic juice into the small intestine:

• Restriction in the diet of vegetable fats (up to 40 mg);

• Prohibition on the use of choleretic agents;

• Reception of antispasmodics: Hymecromon (Odeston) or Duspatalin (Mebeverin), Trimyodate (Trimebutin), No-shpa (drotaverine hydrochloride).

A symptom of sphincter dysfunction is attacks of pain in the epigastric region or in the right hypochondrium, lasting over 20 minutes for 3 months or more.

Additional prescribed drugs:

• Enzymes – Pancreatin, Festal, Creon, Mezim-forte;

• Hepatoprotectors – Karsil, LIV-52, Hepabene, Legalon.

Enzymes are prescribed by a gastroenterologist based on the results of coprography, and hepatoprotectors – in case of prolonged damage to the liver by Giardia toxins. In this case, a biochemical blood test shows an excess of the level of ALT and AST enzymes.

Stage number 2 in the treatment of giardiasis – destruction

Diagnosing giardiasis in a child means that almost all family members have this disease.

Groups of drugs for the treatment of giardiasis:

1. Nitroimidazole group: Tinidazole, Ornidazole. To one of the drugs in this group – Metronidazole – Giardia developed high resistance, it is not recommended for treatment.

2. Nitrofuran group – Macmirror, Nifuratel. The drug Furazolidone, previously actively used to treat giardiasis, is no longer used due to the large number of side effects and parasite resistance to it.

3. The benzimedazole group is Albendazole.

The probiotic Enterol, which contains active microorganisms – Saccharomycetes Bouvardia – is used in any treatment regimen for giardiasis. It enhances and complements the action of specific drugs, has a detrimental effect on parasites.

Ornidazole

It is offered to consumers under the trade names: Gairo, Tiberal, Ornisid, Dazolik, Ornidazol-vero. Available in the form of tablets, solution for infusion and vaginal suppositories. For the treatment of giardiasis, oral administration is used (0,5 g tablets). The effectiveness of the drug is close to 90%.

Treatment regimens:

• According to the first scheme, the treatment of giardiasis is carried out at one time. Children weighing up to 35 kg receive a medicinal dose of 0,03-0,04 g/kg of body weight. Tablets for them are crushed. Children weighing over 35 kg and adults take 3 pcs. (1,5 g) at one time at night.

• The second scheme is intended for the treatment of adult patients, it provides for taking the medicine for 36 hours, 1 pc. every 12 hours.

Contraindications to the use of Ornidazole:

• First trimester of pregnancy;

• Lactation (alternative – temporary cessation of breastfeeding);

• Children’s age up to 12 years;

• Individual intolerance to the components of the drug.

With caution, it is recommended to take the remedy for epilepsy, multiple sclerosis, hepatitis, alcoholism, in the second and third trimester of pregnancy.

Side effects of the drug:

• Convulsions and trembling of the limbs;

• Brief loss of consciousness;

• fatigue, drowsiness;

• Disorders of the digestive system;

• Allergic reaction.

Tinidazole

The broad-spectrum drug is intended for antimicrobial and antiprotozoal therapy. Tinidazole is produced in India and offered to consumers in the form of tablets weighing 0,5 g (pack contains 4 pieces). The drug has an efficiency of about 77%.

Giardiasis treatment regimen:

• For the treatment of giardiasis, it is enough for an adult to take 2 g of Tinidazole (4 pcs.) at a time.

• Children’s dosage is calculated individually, based on 50 mg / kg of body weight.

It is possible to take the drug again in the same dosage if the first course was ineffective.

Contraindications:

• Children’s age up to 12 years;

• lactation and pregnancy;

• Intolerance to the drug;

• Inhibition of bone marrow function;

• Organic diseases of the nervous system.

Side effects when using Tinidazole:

• Allergic manifestations: pruritus, ganglioneuroma;

• Digestive disorders: dyspepsia, lack or loss of appetite, diarrhea, dry mouth;

• Transient leukopenia (rare);

• Violations of the functionality of the nervous system: disorder of coordination of movements, headache, dizziness, dysarthria, convulsions, weakness.

Nifuratel

The trade name of the drug is Macmirror, it is available in the form of tablets (0,2 g), as well as suppositories and ointments for topical use. Treatment with this highly active agent gives the best results to date.

The reasons for the high efficiency of Nifuratel:

• Almost completely excreted by the kidneys, therefore it gives a minimum of side effects (2% of the total number of patients);

• Simultaneously with the therapy of giardiasis, it destroys pathogens of intestinal infections (shigella, salmonella, etc.);

• Effectively acts against Helicobacter pylori, fungi of the genus Candida, which often accompany giardiasis;

Treatment Scheme:

• Children receive a therapeutic dosage of 10-30 mg/kg of body weight during the week. The daily dose is divided into 2 doses.

• Adults take 0,4 g (2 pcs.) During the week, 2-3 times a day.

Contraindications for use are minor. Basically, this is an allergy to the active substance Nifuratel. Take the drug with caution during pregnancy, as it crosses the placental barrier. Breastfeeding during treatment with this remedy is not possible.

Side effects occur very rarely:

• Bitterness in the mouth, vomiting;

• Heartburn;

• allergic itching;

• Gastralgia, diarrhea.

Albendazole

A universal anthelmintic agent is offered to consumers under the trade names Nemozol, Aldazol, Sanoksal, Gelmodol. The drug is available in the form of tablets of 0,4 g (1-3 pieces per pack), as well as in the form of a suspension. Albendazole is effective against most types of helminths at all stages of their development – from eggs to mature individuals. It acts on parasites not only in the gastrointestinal tract, but also in other organs and tissues.

Contraindications:

• Children’s age up to 6 years (in some sources up to 2 years);

• Pregnancy in all trimesters;

• Breastfeeding period:

• Retinal lesions;

• Disorders of the bone marrow;

• Allergy to the active substance in the preparation.

Treatment Scheme:

• Adults take Albendazole once a day, 0,4 g (1 pc.) After meals. The course of treatment takes from 3 to 5-7 days. With poor tolerance, you can limit yourself to 3-4 days.

• Children from 6 years of age are prescribed from 10 to 15 mg of suspension per 1 kg of body weight once. The course of treatment takes 4-5 days.

Side effects of Albendazole:

• Renal failure;

• Headache and dizziness;

• Skin itching, allergies;

• Leukopenia, granulocytopenia;

• Increased blood pressure;

• Hyperthermia, fever;

• Nausea, discomfort in the epigastric region.

An overdose of the drug leads to an increase in the intensity of side effects. Helping the patient is to wash the stomach and take enterosorbents.

Enterol

The drug belongs to the group of probiotics, it is produced in France and offered to consumers in the form of capsules in a soluble shell and powder packaged in sachets. It increases the activity of intestinal enzymes, immunoglobulin, sucrase, maltase and lactase, and normalizes the intestinal microflora. Enterol contains fungal microorganisms of the genus Saccharomycete boulardii, which are active in the digestive tract for 2-5 days after taking the drug.

The tool complements and enhances the therapeutic effect of most drugs for the treatment of giardiasis, with the exception of Nifuratel. Enterol has an antiprotozoal effect, reduces the concentration of lamblia in the intestine.

Contraindications:

• Children’s age up to a year (due to the anatomical structure of the intestines of infants and the high risk of its permeability to fungi);

• High sensitivity to the components of the drug;

• The presence of a central venous catheter;

• Pregnancy.

Treatment Scheme:

• Children from 1 to 3 years old – the contents of the capsule are dissolved in water and given to the child 2 times a day for 5 days;

• Children over 3 years old and adults – 1 capsule or the contents of 1 sachet 1-2 times a day for 5-7 days.

Enterol very rarely causes side effects, they can manifest themselves in the form of allergies and pain in the stomach.

Stage number 3 in the treatment of giardiasis – recovery

After the death of parasites, the body will need recovery. It can take a long time, depending on how massive the parasitic invasion was.

To restore the intestinal microflora, disturbed by the presence of lamblia in it, vitamin complexes with trace elements are used:

• Stimbifide with trace elements (zinc, selenium, oligofructose, inulin) and vitamins C, E, B₁, B₂, B₃, B₅, B_6, B₈, B₉, B₁₂. Can be used for all age categories from 6 months. The course of admission is 1 month, 2-3 pcs. while eating.

• Bion-3 with trace elements (calcium, chromium, zinc, iron, molybdenum, iodine, selenium, manganese), lacto- and bifidobacteria of two types, vitamins A, C, B₁, B₂, B₅, B_6, B₈, B₉, B₁₂, PP, D₃. The course of admission is 1 month, they are used from the age of 14. Tablets are taken once, without dividing into parts, 1 pc. In addition to the vitamin course, Enterol is treated. Children under 3 years old take it for 5 days, the rest – for 10 days.

To increase the immunity affected by the activity of parasites, you can use immunomodulators:

• Polyoxidonium is a new generation medicine created by Russian scientists, used in the form of suppositories, tablets, and lyophilisate for preparing a solution. In children from 6 months of age, the remedy is used in the form of drops in the nose, from 12 years old it is possible to use all forms. The drug has no contraindications.

• Likopid – an immunomodulator in the form of tablets, is used in adults and children from the first months of life at a dosage of 1-10 mg. Contraindications – lactation, pregnancy, autoimmune thyroiditis, diseases accompanied by hyperthermia (more than +38 ° C) or fever.

In order for the treatment of giardiasis to be effective, which drug to choose?

A two-stage course of taking different drugs can provide a complete cure for Giardia. The interval between them is 1 week.

Preparations for the course of treatment of children:

• Ornidazole (or Tinidazole) – in the treatment of children, Tinidazole is used from the age of 12, Ornidazole – at any age;

• Nifuratel – from 2 months of a child’s life;

• Albendazole – from 2 years (in some sources – from 6 years).

The first course of treatment in children and adults is carried out in most cases with Ornidazole (Tinidazole).

The second course – use Nifuratel with its excellent tolerance, or universal Albendazole, which destroys all existing parasites. Simultaneously with these drugs, Enterol is used at the second stage of treatment.

Possible allergic reactions are stopped by the following means:

• Zyrtec (Cetirizine) – for children from six months;

• Telfast – for children from 12 years old.

In addition to the above drugs, the use of Wobenzym is recommended. It is a complex of enzymes of natural origin, exhibits anti-inflammatory, immunomodulatory properties. Children can take Wobenzym 1 tablet per 5 kg of weight, adults – 3-5 pcs. 3 times a day.

Prevention of giardiasis

The prevalence of giardiasis makes it necessary to be extremely attentive to its symptoms and preventive measures. Particular attention should be paid to the health of young children.

Preventive measures against infection with Giardia:

• Teaching children basic hygiene skills;

• Prevention of the appearance of bad habits in children: sucking fingers or a pencil, biting nails;

• Thorough washing of vegetables and fruits with rinsing them with boiled water;

• Refusal to eat on the street and the use of “fast food” products;

• A ban on swimming in unfamiliar water bodies, as well as on the use of water from surface sources for drinking and cooking;

• Drinking exclusively boiled or bottled water;

• A ban on children’s games with sand and earth at the risk of contact in this environment with animal feces;

• Cohabitation with pets is allowed, provided that all family members, and especially children, observe strict hygiene rules.

Pets that come into contact with humans must be regularly dewormed. Family members with cats or dogs undergo prophylactic treatment with Albendazole preparations every 4-6 months (adults 400 mg once in the form of tablets, children – 6-10 mg / kg of body weight in the form of a suspension).

Video about the ways of infection and treatment of giardiasis: