61350 20190819101354.0 doi 10.1093/infdis/jix066 sideral 98776 ART-2017-98776 eng Requena-Méndez, A. The Use of Quinacrine in Nitroimidazole-resistant Giardia Duodenalis: An Old Drug for an Emerging Problem. 2017 Access copy available to the general public Unrestricted Background: There is little evidence regarding the management of refractory giardiasis after treatment with nitroimidazoles. This study estimates the proportion of persistent giardiasis in 3 hospitals in Barcelona, describes associated risk factors and genotype, and evaluates the efficacy rate of quinacrine in those with persistent giardiasis. Methods: A clinical, prospective, observational study was conducted in patients with giardiasis treated with nitroimidazoles. Those with persistent giardiasis were provided quinacrine. Molecular characterization of Giardia isolates was performed by polymerase chain reaction amplification of a fragment of tpi and bg genes. Results: Seventy-seven patients were recruited and treated with nitroimidazoles, and in 14 of 71 (20%) of patients followed up, Giardia persisted. Refractory giardiasis was associated with malaise (P = .007) and anorexia (P = .02), with previous giardiasis (P = .03), and with previous antibiotic (P = .02) or antiparasitic(P = .04) use. Quinacrine had an effectiveness rate of 100% in refractory giardiasis (n = 13; 95% confidence interval = 75-100). Molecular characterization showed that 17 (25%) Giardia isolates belonged to assemblage A, and 31 (43%) belonged to assemblage B. In refractory giardiasis, assemblage A and B were found responsible in 4 and 6 cases, respectively. Conclusions: Almost 20% of patients presented persistent giardiasis, belonging to both assemblages A and B, after nitroimidazole. Short course of quinacrine was effective in treating refractory cases. Further controlled studies should evaluate its efficacy and safety. info:eu-repo/grantAgreement/ES/DGA/B124 info:eu-repo/grantAgreement/ES/MINECO/FIS/PI09-1585 info:eu-repo/semantics/openAccess All rights reserved http://www.europeana.eu/rights/rr-f/ 5.186 2017 IMMUNOLOGY 35 / 155 = 0.226 2017 Q1 T1 MICROBIOLOGY 20 / 125 = 0.16 2017 Q1 T1 INFECTIOUS DISEASES 9 / 88 = 0.102 2017 Q1 T1 3.302 2017 Infectious Diseases 2017 Q1 Immunology and Allergy 2017 Q1 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion (orcid)0000-0003-0765-7227 Goñi, P. Universidad de Zaragoza (orcid)0000-0002-9273-5885 Rubio, E. Universidad de Zaragoza Pou, D. Fumadó, V. Lóbez, S. Aldasoro, E. Cabezos, J. Valls, M.E. Treviño, B. Martínez, Montseny, A.F. (orcid)0000-0001-5829-9787 Clavel, A. Universidad de Zaragoza Gascon, J. Muñoz, J. 1008 660 Universidad de Zaragoza Dpto. Microb.Med.Pr.,Sal.Públ. Área Parasitología 1008 615 Universidad de Zaragoza Dpto. Microb.Med.Pr.,Sal.Públ. Área Medic.Prevent.Salud Públ. 215, 6 (2017), 946-953 J. infect. dis. JOURNAL OF INFECTIOUS DISEASES 0022-1899 242861 http://zaguan.unizar.es/record/61350/files/texto_completo.pdf Versión publicada 131662 http://zaguan.unizar.es/record/61350/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:61350 articulos driver 2019-08-19-09:51:50 ARTICLE