Treatment of refractory paediatric giardiasis using secnidazole plus albendazole: a case series.

Giardia lamblia, the aetiological agent of human giardiasis, is a frequently identified protozoan infection of the upper small intestine. It mainly affects children and has a wide range of clinical manifestations, from asymptomatic carriage to acute or chronic diarrhoea with dehydration, abdominal pain, nausea, vomiting, excessive flatulence and weight loss. Standard treatment for giardiasis is commonly with 5-nitroimidazole (5-NI) compounds, or nitazoxanide; however, some individuals experience treatment failure. For such patients, a combination of two or more drugs may be a viable approach. We report our experience with 11 paediatric patients with drug-refractory giardiasis, for whom therapy with a combination of secnidazole (SNZ) (30 mg/kg/day, divided into 2 doses, for 3 days) and albendazole (ABZ) (400 mg daily for 5 days) resulted in cure for 9 of the 11 (82%) patients. This combination of drugs was well tolerated; only mild, transient, and self-limited side effects were reported and these did not require discontinuation of treatment. These results support the use of SNZ plus ABZ as an alternative treatment for paediatric patients with giardiasis who have failed conventional treatments. Further research is needed to establish the safety of this combination and how it compares to other combination strategies.

Chloroquine: An Old Drug with New Perspective Against Giardiasis.

The occurrence of treatment failures to first-line treatment for giardiasis, one of the most widespread although neglected parasitic disease, has long been recognised. Nowadays, it starts to represent a great challenge to clinicians, especially in endemic countries. This requires the introduction of new drug interventions, but the development of novel drugs is a time and money consuming effort with most of the compounds never reaching the market. Consequently, alternative strategies are needed, especially for the treatment of giardiasis. Chloroquine (CQ), a synthetic drug developed as antimalarial agent, has been shown to also exert antigiardial activity. Here, we present a mini-research summarizing results on the treatment of human clinical cases with CQ, going through in vitro research, case report, and case series to human clinical trials, highlighting the benefits and mentioning possible adverse effects.

Chloroquine: an old drug with new perspective against giardiasis

The occurrence of treatment failures to first-line treatment for giardiasis, one of the most widespread although neglected parasitic disease, has long been recognised. Nowadays, it starts to represent a great challenge to clinicians, especially in endemic countries. This requires the introduction of new drug interventions, but the development of novel drugs is a time and money consuming effort with most of the compounds never reaching the market. Consequently, alternative strategies are needed, especially for the treatment of giardiasis. Chloroquine (CQ), a synthetic drug developed as antimalarial agent, has been shown to also exert antigiardial activity. Here, we present a mini-research summarizing results on the treatment of human clinical cases with CQ, going through in vitro research, case report, and case series to human clinical trials, highlighting the benefits and mentioning possible adverse effects

Terapia continua con sertralina en el trastorno disfórico premenstrual. A propósito de un caso clínico / Continuous therapy with sertraline in premenstrual dysphoric disorder. Presentation of a clinical case

El trastorno disfórico premenstrual es un trastorno mental aparentemente poco frecuente y en no pocas ocasiones se vuelve discapacitante para quien lo presenta. En estos casos, la terapia farmacológica con antidepresivos inhibidores de la recaptación de serotonina es casi imprescindible para la remisión de este trastorno. En algunos casos la terapéutica puede llevarse de forma intermitente durante cada periodo premenstrual; sin embargo, en este estudio la terapia continua con sertralina resultó muy eficaz. El siguiente caso es el de una paciente de 21 años de edad, traída a nuestro servicio de psiquiatría por presentar un cuadro ansioso-depresivo previo a su ciclo menstrual, donde se le indicó tratamiento con un antidepresivo tricíclico. Si bien mejoró, al poco tiempo regresó con un cuadro peor que el inicial, por lo que se decidió realizar un seguimiento ambulatorio. En el servicio se concluyó iniciar terapia continua con sertralina; al principio se observó una mejoría y luego una remisión total del cuadro. Tras varios meses de seguimiento, no se ha observado recaída y tampoco se notifican reacciones adversas en esta paciente (AU)

Premenstrual dysphoric disorder is a relatively uncommon mental disorder, but in many cases it becomes disabling for the person who suffers it, and in these cases pharmacological therapy with antidepressants is essential for the remission of this disorder. In some cases the therapy may be carried intermittently during each premenstrual period, however in this study continuous therapy with sertraline proved to be very effective. The following case concerns a 21-year-old woman referred to our psychiatry department due to presenting with a depressive condition prior to her menstrual cycle. She improved after being prescribed a treatment with a tricyclic antidepressant, but she returned later with worse symptoms than before. In the department it was decided to start sertraline continuously, with which an improvement was observed initially, and a complete remission within a few weeks. With several months of follow-up, no relapse or adverse events were reported (AU)

Potenciación con carbamazepina en la depresión mayor resistente. A propósito de un caso clínico / Augmentation therapy with carbamazepine in treatment-resistant major depression. A case report

La depresión es un trastorno mental relativamente frecuente y no en pocas ocasiones se vuelve discapacitante para quien la padece; en estos casos, la terapia farmacológica con antidepresivos es imprescindible para la remisión de esta. En algunos casos, la potenciación con fármacos no antidepresivos propiamente dichos puede ser una alternativa con muy buenos resultados en la práctica clínica. El siguiente caso trata de una paciente de 48 años, remitida por su médico de familia por presentar un cuadro de depresión mayor de varios meses de evolución. Después de habérsele prescrito varios antidepresivos, incluso algunos en combinación, no hubo buena respuesta, por lo que se determinó hospitalizar. En el servicio de psiquiatría se decidió la potenciación con carbamazepina unida a la sertralina. Al principio se observó una mejoría, con una remisión total de la depresión a las pocas semanas. Tras varios meses de seguimiento, no se ha observado recaída y tampoco se notifican reacciones adversas (AU)

Depression is a relatively common mental disorder, and it often becomes debilitating for the sufferer. In these cases antidepressant drug therapy is essential for its remission. In some cases, augmentation with non-antidepressant drugs can be an alternative, with very good results in clinical practice. The following case concerns a patient of 48 years, referred by her Primary Care doctor, due to presenting with a major depressive disorder of several months onset. As there was an unsatisfactory response after having been prescribed several antidepressants, including some in combination, it was decided to admit to hospital Augmentation treatment with carbamazepine and sertraline was decided by the Psychiatric Department. An improvement was observed at first, followed by complete remission of depression within a few weeks. After several months of follow-up, she has not relapsed, and no side effects were reported (AU)