Persistent/refractory Giardiasis

RE: Persistent/refractory Giardiasis

Roland Bulkyn-Rackowe — Thu, 23 Nov 2017 19:23:00 GMT

I've used 7 days on 7 off, 7 on fenbendazole with good disinfection. If it's been going on some weeks I'd give B12 on top (either weekly injections or 1000mcg orally daily).

I have little faith in a -ve campylobacter culture, it's about 50-60% sensitive via the method most labs use. I'll usually do a rectal swab and have a look at the faeces. This has the best yield in puppies / kittens (giardia, campylobacter, coccidia, trichomonas etc).

RE: Persistent/refractory Giardiasis

Mark Hedberg — Thu, 23 Nov 2017 11:44:33 GMT

[quote user="David Mills"]

[quote user="Mark Hedberg"]i heard anecdotally that there is a mild immunomodulatory effect attributed to metronidazole but take that with a grain of salt)[/quote]

Why? It's very well established. Acts mainly in the colonic mucosa.

[/quote]

Ooh, excellent! I must admit i had only heard it in passing and wasn't certain how established the evidence was, so thought i'd temper my recommendation because it was off my own back, as it were. :)

Glad to hear!

RE: Persistent/refractory Giardiasis

David Mills — Wed, 22 Nov 2017 20:17:48 GMT

[quote user="Mark Hedberg"]i heard anecdotally that there is a mild immunomodulatory effect attributed to metronidazole but take that with a grain of salt)[/quote]

Why? It's very well established. Acts mainly in the colonic mucosa.

RE: Persistent/refractory Giardiasis

David Mills — Wed, 22 Nov 2017 20:16:24 GMT

Probably reinfection on top of something else going on.

Metronidazole only 65% effective vs Giardia. Fenbendazole some resistance too.

Aziyhromycin has been used successfully (7d course) esp in chronic offenders. Tmps also works against some.

Cysts cling to the fur so dog needs washing 1-2x daily especially perineum. An EC may be useful for a week.

Environmental disinfection needs at least 10 minutes to work.

Probably need to look deeper for underlying cause

RE: Persistent/refractory Giardiasis

Mark Hedberg — Wed, 22 Nov 2017 19:43:01 GMT

with cases suspicious of giardia i don't do 3-5 day courses anymore, got too many relapses; 7-10 days of panacur. If a severe nasty case, I give the panacur (7-10 days) together with 7-10 days of metronidazole (i heard anecdotally that there is a mild immunomodulatory effect attributed to metronidazole but take that with a grain of salt) and that seems to work well.

Good luck!

RE: Persistent/refractory Giardiasis

Thomas Johnson — Wed, 22 Nov 2017 16:40:20 GMT

[quote user="KMurphy"] I don't know that he's passed much solid at all - it improves then worsens again but never goes back to normal.[/quote]

It would be interesting to know if he is better on metronidazole rather then fenbendazole as that might indicate an antibiotic responsive enteritis.

RE: Persistent/refractory Giardiasis

KMurphy — Wed, 22 Nov 2017 16:10:53 GMT

[quote user="Thomas Johnson"] I assume the rest of the faecal tests were negative?[/quote]

We cultured Campylobacter on the one before this one but it's clear on the latest sample. I don't know that he's passed much solid at all - it improves then worsens again but never goes back to normal.

We haven't done folate and B12 yet because we've found an abormality on the faecal tests every time. It's something to consider. He's in this evening again so I'll see how he's getting on.

RE: Persistent/refractory Giardiasis

Thomas Johnson — Wed, 22 Nov 2017 14:47:59 GMT

[quote user="KMurphy"]I've been treating a Labrador puppy that has Giardia since September. We've done three rounds of Panacur and two rounds of metronidazole but his latest test still shows Giardia cysts present and he's still having diarrhoea. He's otherwise very well and gaining weight but the persistent diarrhoea is obviously not great.[/quote]

I'd be concerned that there is more than just giardia going on, it shouldn't be this difficult to clear up a simple giardia infection! Does the diarrhoea resolve while he's on either fenbendazole or metronidazole? or does it continue regardless? Could there be another problem that predisposes him to the giardia infection? I assume the rest of the faecal tests were negative? Have you checked things like folate and B12? Diet trial?

RE: Persistent/refractory Giardiasis

Jenny Harris — Wed, 22 Nov 2017 14:41:55 GMT

Are they washing the dog very regularly? As if he is having diarrhoea which is contaminating his coat that could be a source of reinfection?

RE: Persistent/refractory Giardiasis

Rob Loxley — Wed, 22 Nov 2017 13:52:16 GMT

Longer course of panacur but I'd be very suspicious of reinfection going on