Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

Giardiasis

Last Updated: November 6, 2013; Last Reviewed: November 6, 2013

Panel's Recommendations for Giardiasis
Panel's Recommendations
  • Giardiasis can be prevented by practicing good hygiene, avoiding drinking or swimming in water that may be contaminated, and not eating food that may be contaminated (AIII).
  • Antiretroviral treatment of HIV-infected children to reverse or prevent severe immunodeficiency is the primary mode of prevention of severe enteric giardiasis (AII*)
  • Combination antiretroviral therapy should be part of primary initial treatment for giardiasis in HIV-infected children (AII*).
  • Dehydration and electrolyte abnormalities should be corrected (AIII)
  • Patients with chronic diarrhea should be monitored for malabsorption leading to malnutrition (AIII)
  • Tinidazole (AII) and nitazoxanide (AI) are preferred and metronidazole (AI) is the alternative recommended treatment for giardiasis in children.
Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = One or more randomized trials in children with clinical outcomes and/or validated endpoints; I* = One or more randomized trials in adults with clinical outcomes and/or validated laboratory endpoints with accompanying data in children from one or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes; II = One or more well-designed, nonrandomized trials or observational cohort studies in children† with long-term outcomes; II* = One or more well-designed, nonrandomized trials or observational studies in adults with long-term clinical outcomes with accompanying data in children from one or more similar nonrandomized trials or cohort studies with clinical outcome data; III = Expert opinion

Studies that include children or children/adolescents, but not studies limited to post-pubertal adolescents

Dosing Recommendations for Prevention and Treatment of Giardiasis
Indication First Choice Alternative Comments/Special Issues
Primary Prophylaxis
cART to avoid advanced immunodeficiency
N/A
N/A
Secondary Prophylaxis
N/A N/A N/A
Treatment
  • Tinidazole, 50 mg/kg by mouth, administered as 1 dose given with food (maximum 2 g). Note: Based on data from HIV-uninfected children

  • Nitazoxanide. Note: Based on data from HIV-uninfected children 
    • 1–3 years: 100 mg by mouth every 12 hours with food for 3 days 
    • 4–11 years: 200 mg by mouth every 12 hours with food for 3 days 
    • ≥12 years: 500 mg by mouth every 12 hours with food for 3 days
Metronidazole 5 mg/kg by mouth every 8 hours for 5-7 days. 

Note: Based on data from HIV-uninfected children 
Tinidazole is approved in the United States for children aged ≥3 years. It is available in tablets that can be crushed.

Metronidazole has high frequency of gastrointestinal side effects. A pediatric suspension of metronidazole is not commercially available but can be compounded from tablets. It is not FDA-approved for the treatment of giardiasis.

Supportive Care
  • Hydration
  • Correction of electrolyte abnormalities
  • Nutritional support 
Antimotility agents (e.g., loperamide) should be used with caution in young children. 
Key to Acronyms: cART = combination antiretroviral therapy; FDA = U.S. Food and Drug Administration

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