University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; University Medical Centre Hamburg-Eppendorf (UKE), Department of Anesthesiology, Hamburg, Germany.
University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.
Travel Med Infect Dis. 2021 Sep-Oct;43:102090. doi: 10.1016/j.tmaid.2021.102090. Epub 2021 Jun 1.
Giardia lamblia is a common cause of diarrhoea in returning travellers. Failure of the recommended first-line treatment, metronidazole, has frequently been observed. Recommendations for treatment of metronidazole-refractory giardiasis lack clarity and evidence.
We conducted a retrospective data analysis of returned travellers with confirmed giardiasis at the Bernhard-Nocht-Clinic in Hamburg, Germany, between 2007 and 2016.
We identified 339 cases of giardiasis, mostly acquired in South Asia (n = 157). 308 patients received metronidazole as first-line treatment, leading to treatment failure in 93 cases. Statistical analysis suggested by far the highest risk of metronidazole treatment failure for travellers returning from South Asia (Odds Ratio 8.73). Second-line therapy consisted of various different therapy regimens. Combination therapy as second-line treatment seemed to be more effective than monotherapy. A repeat course of metronidazole proved to be futile.
This study reveals a strikingly low effectiveness of metronidazole, especially in patients returning from South Asia. Second-line treatment showed inconsistency of regimens and yielded unsatisfactory results. These findings require reconsideration of treatment strategies for giardiasis. Large prospective trials are urgently needed to assess new first-line treatment options and to help implement advice for effective, agreed second-line treatment strategies. Translational projects should be created to link the understanding of resistance mechanisms with epidemiological data and clinical outcome.
蓝氏贾第鞭毛虫是旅行者腹泻的常见病因。推荐的一线治疗药物甲硝唑经常失败。甲硝唑难治性贾第虫病的治疗建议缺乏明确性和证据。
我们对 2007 年至 2016 年期间在德国汉堡 Bernhard-Nocht 诊所确诊为贾第虫病的返回旅行者进行了回顾性数据分析。
我们确定了 339 例贾第虫病病例，主要在南亚（n=157）获得。308 例患者接受甲硝唑作为一线治疗，导致 93 例治疗失败。统计分析表明，来自南亚的旅行者甲硝唑治疗失败的风险最高（优势比 8.73）。二线治疗包括各种不同的治疗方案。联合治疗作为二线治疗似乎比单一药物治疗更有效。重复使用甲硝唑证明是无效的。
本研究表明甲硝唑的疗效明显降低，特别是在来自南亚的患者中。二线治疗方案不一致，结果不理想。这些发现需要重新考虑贾第虫病的治疗策略。迫切需要进行大型前瞻性试验，以评估新的一线治疗选择，并帮助实施有效的、商定的二线治疗策略建议。应创建转化项目，将耐药机制的理解与流行病学数据和临床结果联系起来。
