From the Guidelines
Paromomycin is not the first-line treatment for Giardia infections, but rather metronidazole or tinidazole are preferred, according to the 2017 Infectious Diseases Society of America clinical practice guidelines 1. The recommended treatment for Giardia infections is metronidazole, typically prescribed at 250 mg three times daily for 5-7 days for adults, or tinidazole, which is approved in the United States for children aged ≥3 years 1.
- Key points to consider when treating Giardia infections include:
- Metronidazole has a high frequency of gastrointestinal side effects, and a pediatric suspension is not commercially available but can be compounded from tablets 1.
- Tinidazole is available in tablets that can be crushed, making it a suitable option for children 1.
- Paromomycin may be considered as a second-line therapy, particularly in pregnant patients, due to its minimal systemic absorption, but its effectiveness and safety profile are not as well-established as metronidazole or tinidazole 1. It is essential to note that the treatment guidelines prioritize metronidazole or tinidazole as the first-line therapy, and paromomycin should only be considered in specific cases where these options are not suitable, as supported by the most recent and highest quality study available 1.
From the Research
Treatment for Giardia with Paromomycin
- Paromomycin is an antiprotozoal medication that can be used as an alternate treatment for giardiasis, especially in pregnant women 2, 3, 4.
- The cure rate of paromomycin for giardiasis varies between 60% and 100% with one course of treatment 2.
- Paromomycin is a non-absorbable aminoglycoside, making it a potentially less toxic agent for treating symptomatic giardiasis in pregnancy 3, 4.
- Compared to other treatments, paromomycin may not be as effective as metronidazole or tinidazole, but it can be used as an alternative when these drugs are contraindicated 2, 4, 5.
Comparison with Other Treatments
- Metronidazole is often considered the first-line treatment for giardiasis, but paromomycin can be used in pregnant women or when metronidazole is not effective 2, 4.
- Tinidazole has been shown to be more effective than metronidazole and albendazole in achieving parasitological cure, but paromomycin may still be used as an alternative in certain cases 5.
- Albendazole may be equivalent to metronidazole in achieving parasitological cure, but paromomycin has been used as an alternative treatment, especially in pregnant women 2, 6.