Children infected with Giardia lamblia who exhibit diarrhea and other symptoms are usually treated with antimicrobial agents. A more difficult challenge is the need to treat asymptomatic or mildly symptomatic children for Giardia infection. Addiss and colleagues review the benefits and risks of managing asymptomatic and nondiarrheal Giardia infection in children.
Arguments for treating asymptomatic giardiasis include benefits to individual children who may have mild nondiarrheal symptoms and benefits for public health reasons, to help control Giardia outbreaks in day care centers. Arguments against treatment include the observations that Giardia is generally well tolerated in healthy children, that medication is expensive, only 70 to 85 percent effective and potentially toxic, and that reinfection is likely. Currently, the American Academy of Pediatrics recommends that asymptomatic Giardia infections not be treated, but fails to define asymptomatic.
Although a child may not have diarrhea with Giardia infection and be considered asymptomatic, other more subtle symptoms may be present. Such symptoms as flatulence, foul-smelling stools, nausea and abdominal pain may occur. Treatment then may be indicated for relief of these symptoms, or if the child has signs of malabsorption or failure to thrive. Although studies are conflicting, the results seem to indicate that in healthy children, Giardia infection probably has little adverse effect, but that in malnourished children, Giardia infection may contribute to poor nutritional status even if diarrhea is not present. Giardia infection may also interfere with the absorption of antibiotics, so treatment should be considered in children with asymptomatic giardiasis and repeated treatment failures for otitis media.
Giardia infections in day care centers are frequent and difficult to control. Total eradication of organisms is nearly impossible, and treatment of uninfected children has not been shown to be effective. One study showed that treating all infected children in a day care setting during a Giardia outbreak had a temporary but not long-term benefit. Another study did not show any improvement in outbreak control from screening and treating all infected children. In some severe outbreaks, however, the treatment of asymptomatic children may be important. In situations in which other measures, such as strict hand washing, isolation of sick children and improved diapering practices fail to contain a day care outbreak, several investigators suggest screening close contacts of infected children and treating those who are also infected. Treating all infected children theoretically reduces potential reservoirs and decreases the prevalence and subsequent transmission of Giardia.
The authors conclude that in well-nourished children, no treatment is probably necessary for asymptomatic Giardia. Certain children with asymptomatic and non-diarrheal disease may benefit from treatment. When other preventive measures are ineffective in day care outbreaks, the risks and benefits of treatment should be carefully assessed, and consideration should be given to treatment of asymptomatic giardiasis. (Pediatric Infectious Disease Journal, November 1991, vol. 10, p. 843.)
COPYRIGHT 1992 American Academy of Family Physicians
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