Treatment and Diagnosis
G. lamblia infection in humans is frequently misdiagnosed. Accurate diagnosis requires an antigen test or, if that is unavailable, an ova and parasite examination of stool. Multiple stool examinations are recommended, since the cysts and trophozoites are not shed consistently. Given the difficult nature of testing to find the infection, including many false negatives, some patients should be treated on the basis of empirical evidence, treating based on symptoms.
Human infection is conventionally treated with metronidazole, tinidazole or nitazoxanide. Although metronidazole is the current first-line therapy, it is mutagenic in bacteria and carcinogenic in mice, so should be avoided during pregnancy. It has not directly been linked to causing cancer in humans, only in other mammals, therefore appears safe. One of the most common alternative treatments is berberine sulfate (found in Oregon grape root, goldenseal, yellowroot, and various other plants). Berberine has been shown to have an antimicrobial and an antipyretic effect. Berberine compounds cause uterine stimulation, and so should be avoided in pregnancy. Continuous high dosing of berberine may lead to bradycardia and hypotension in some individuals.
| Drug | Treatment duration | Possible side effects |
|---|---|---|
| Metronidazole | 5–7 days | Metallic taste; nausea; vomiting; dizziness; headache; disulfiram-like effect; neutropenia |
| Tinidazole | Single dose | Metallic taste; nausea; vomiting; belching; dizziness; headache; disulfiram-like effect |
| Nitazoxanide | 3 days | Abdominal pain; diarrhea; vomiting; headache; yellow-green discolouration of urine |
| Albendazole | 5 days | Dizziness; headache; fever; nausea; vomiting; temporary hair loss |
Table adapted from Huang, White.
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