The Hospital for Tropical Diseases, UK.
The Hospital for Tropical Diseases, UK.
Clin Microbiol Infect. 2018 Jan;24(1):37-42. doi: 10.1016/j.cmi.2017.05.028. Epub 2017 Jun 15.
Giardia intestinalis is microaerophilic diarrhoea-causing protozoan common in countries with suboptimal sanitation. Standard treatment is with nitroimidazoles, but a growing number of refractory cases is being reported. Treatment failure has become increasingly prevalent in travellers who contract giardiasis in Asia. Clinicians are increasingly falling back on second-line and less well-known drugs to treat giardiasis.
To review nitroimidazole-refractory G. intestinalis infection, examine the current efficacy of standard therapeutic agents, consider potential resistance mechanisms which could cause treatment failure and describe the practical aspects of managing this emerging clinical problem.
A PubMed search was conducted using combinations of the following terms: refractory, Giardia, giardiasis, resistance and treatment. Articles on the pharmacotherapy, drug resistance mechanisms and use of alternative agents in nitroimidazole-refractory giardiasis were reviewed.
We review the standard drugs for giardiasis, including their efficacy in initial treatment, mode of action and documented in vitro and in vivo drug resistance. We assess the efficacy of alternative drugs in nitroimidazole-refractory disease. Existing data suggest a potential advantage of combination treatment.
An optimal treatment strategy for refractory giardiasis has still to be determined, so there is no standard treatment regimen for nitroimidazole-refractory giardiasis. Further work on drug resistance mechanisms and the use of drug combinations in this condition is a priority.
肠道贾第虫是一种微需氧的腹泻性原生动物，在卫生条件较差的国家很常见。标准治疗方法是使用硝基咪唑类药物，但越来越多的难治性病例被报道。在亚洲感染贾第虫的旅行者中，治疗失败的情况越来越普遍。临床医生越来越多地依赖二线药物和不太知名的药物来治疗贾第虫病。
回顾硝基咪唑类难治性 G. 肠道感染，检查标准治疗药物的当前疗效，考虑可能导致治疗失败的潜在耐药机制，并描述管理这一新兴临床问题的实际方面。
使用以下术语的组合在 PubMed 上进行了搜索：难治性、贾第虫、贾第虫病、耐药性和治疗。综述了关于硝基咪唑类难治性贾第虫病的药物治疗、耐药机制以及替代药物应用的文章。
我们回顾了贾第虫病的标准药物，包括它们在初始治疗中的疗效、作用机制以及已证明的体外和体内药物耐药性。我们评估了替代药物在硝基咪唑类难治性疾病中的疗效。现有数据表明联合治疗可能具有优势。
仍然需要确定难治性贾第虫病的最佳治疗策略，因此对于硝基咪唑类难治性贾第虫病没有标准的治疗方案。进一步研究耐药机制以及在这种情况下使用药物联合治疗是当务之急。
