5-Nitroimidazole refractory giardiasis is common in Matanzas, Cuba and effectively treated by secnidazole plus high-dose mebendazole or quinacrine: a prospective observational cohort study

Einarsson, 2016, An up-date on Giardia and giardiasis, Curr Opin Microbiol, 34, 47, 10.1016/j.mib.2016.07.019 Robertson, 2010, Giardiasis – why do the symptoms sometimes never stop?, Trends Parasitol, 26, 75, 10.1016/j.pt.2009.11.010 Lalle, 2018, Treatment-refractory giardiasis: challenges and solutions, Infect Drug Resist, 11, 1921, 10.2147/IDR.S141468 Rogawski, 2017, Determinants and impact of Giardia infection in the first 2 years of life in the MAL-ED Birth Cohort, J Pediatr Infect Dis Soc, 6, 153, 10.1093/jpids/piw082 Rivero, 2008, Cuban parasitology in review: a revolutionary triumph, Trends Parasitol, 24, 440, 10.1016/j.pt.2008.06.008 Escobedo, 2008, Prevalence, risk factors and clinical features associated with intestinal parasitic infections in children from San Juan y Martinez, Pinar del Rio, Cuba, West Indian Med J, 57, 377 Cañete, 2017, Prevalence and factors associated with intestinal parasitic infection among school children from Jagüey Grande Municipality in Matanzas Province, Cuba, West Ind Med J, 66, 361 Canete, 2012, Intestinal parasites in children from a day care centre in Matanzas City, Cuba, PLoS One, e51394, 10.1371/journal.pone.0051394 Canete, 2018, Effectiveness and tolerability of 3-day mebendazole treatment of Giardia duodenalis infection in adults and children: two prospective, open-label phase IV Trials, Curr Ther Res Clin Exp, 89, 43, 10.1016/j.curtheres.2018.11.002 Ansell, 2015, Drug resistance in Giardia duodenalis, Biotechnol Adv, 33, 888, 10.1016/j.biotechadv.2015.04.009 Nabarro, 2015, Increased incidence of nitroimidazole-refractory giardiasis at the hospital for tropical diseases, London: 2008–2013, Clin Microbiol Infect, 21, 791, 10.1016/j.cmi.2015.04.019 Carter, 2018, Nitroimidazole-refractory giardiasis: a growing problem requiring rational solutions, Clin Microbiol Infect, 24, 37, 10.1016/j.cmi.2017.05.028 Almirall, 2011, Mebendazole compared with secnidazole in the treatment of adult giardiasis: a randomised, no-inferiority, open clinical trial, J Parasitol Res, 2011 Canete, 2012, Albendazole versus metronidazole in the treatment of adult giardiasis: a randomized, double-blind, clinical trial, Curr Med Res Opin, 28, 149, 10.1185/03007995.2011.637915 Canete, 2006, Randomized clinical study of five days apostrophe therapy with mebendazole compared to quinacrine in the treatment of symptomatic giardiasis in children, World J Gastroenterol, 12, 6366, 10.3748/wjg.v12.i39.6366 Leitsch, 2015, Drug resistance in the microaerophilic parasite giardia lamblia, Curr Trop Med Rep, 2, 128, 10.1007/s40475-015-0051-1 Tejman-Yarden, 2011, Impaired parasite attachment as fitness cost of metronidazole resistance in Giardia lamblia, Antimicrob Agents Chemother, 55, 4643, 10.1128/AAC.00384-11 Yadav, 2014, Refractory giardiasis: a molecular appraisal from a tertiary care centre in India, Indian J Med Microbiol, 32, 378, 10.4103/0255-0857.142236 Ordonez-Mena, 2018, Comparative efficacy of drugs for treating giardiasis: a systematic update of the literature and network meta-analysis of randomized clinical trials, J Antimicrob Chemother, 73, 596, 10.1093/jac/dkx430 Nash, 2001, Treatment of patients with refractory giardiasis, Clin Infect Dis, 33, 22, 10.1086/320886 Lopez-Velez, 2010, Short course combination therapy for giardiasis after nitroimidazole failure, Am J Trop Med Hyg, 83, 171, 10.4269/ajtmh.2010.09-0742 Morch, 2008, Treatment-ladder and genetic characterisation of parasites in refractory giardiasis after an outbreak in Norway, J Infect, 56, 268 Cacopardo, 1995, [Synergic effect of albendazole plus metronidazole association in the treatment of metronidazole-resistant giardiasis], Clin Ter, 146, 761 Dingsdag, 2018, Metronidazole: an update on metabolism, structure-cytotoxicity and resistance mechanisms, J Antimicrob Chemother, 73, 265, 10.1093/jac/dkx351 Upcroft, 2001, Drug targets and mechanisms of resistance in the anaerobic protozoa, Clin Microbiol Rev, 14, 150, 10.1128/CMR.14.1.150-164.2001 Escobedo, 2003, A randomized trial comparing mebendazole and secnidazole for the treatment of giardiasis, Ann Trop Med Parasitol, 97, 499, 10.1179/000349803235002380 González, 2010, Nitazoxanide for the treatment of Giardia duodenalis infection: a comparative trial with secnidazole, Turk Bull Hyg Exp Biol, 67, 113 Escobedo, 2008, The treatment of giardiasis in children: single-dose tinidazole compared with 3 days of nitazoxanide, Ann Trop Med Parasitol, 102, 199, 10.1179/136485908X267894 Canete, 2010, A randomized, controlled, open-label trial evaluating the efficacy and safety of chloroquine in the treatment of giardiasis in children, West Indian Med J, 59, 607 Escobedo, 2015, Chloroquine: an old drug with new perspective against giardiasis, Recent Pat Antiinfect Drug Discov, 10, 134, 10.2174/1574891X10666150914122118 Escobedo, 2003, Comparison of chloroquine, albendazole and tinidazole in the treatment of children with giardiasis, Ann Trop Med Parasitol, 97, 367, 10.1179/000349803235002290 Granados, 2012, Drugs for treating giardiasis, Cochrane Database Syst Rev, 12 Canete, 2009, Mebendazole in parasitic infections other than those caused by soil-transmitted helminths, Trans R Soc Trop Med Hyg, 103, 437, 10.1016/j.trstmh.2008.11.029 Requena-Mendez, 2017, The use of quinacrine in nitroimidazole-resistant giardia duodenalis: an old drug for an emerging problem, J Infect Dis, 215, 946, 10.1093/infdis/jix066