Drug resistance in Giardia: clinical versus laboratory isolates.

The advantages and limitations of determining mechanisms of drug resistance in Giardia duodenalis laboratory isolates, which have been generated in a number of ways, is weighed against the difficulty of analysing mechanisms in clinical isolates with a large diversity of genetic and expression capabilities. Using isogenic strains to follow changes in enzyme regulation involved in drug resistance, we have been able to assess the full capability of the parasite in developing drug resistance mechanisms. The complementarity of the two approaches, clinical versus laboratory induced drug resistance, and continuing comparison with other organisms, particularly the anaerobic bacteria with which Giardia has strong affiliations, is emphasized. These considerations lead to the study of the population genetics of drug resistance, and strategies critical for rational drug usage, design and therapy.