Giardia and Flagyl (metronidazole)

I came back from India 5 weeks ago with giardia and I was really knocked out by it. The symptoms had started before I left and then a sample was tested here which showed it was giardia.

I was put on flagyl (metronidazole), 400mg 3 times a day for 7 days. It seemed to be getting better, and I started getting a little more active.

But then the symptoms came back, with a vengeance. (so I was wondering had I been put on the correct dose?) I sent off another sample to be tested, but it came back negative. My GP said that you can have false negatives, so I've sent yet another sample, but she's put me on flagyl again anyway.

My friend collected the prescription for me today, and the pharmacist was horrified by the dose I've been put on: 400mg 5 times a day for 3 days. The pharmacist had never dispensed such a heavy dose, and told my friend it would make me feel really awful.

I'm going to phone the GP tomorrow to check about it, but I want to ask about other people's experiences of giardia - did you find flagyl effective? Can you remember what the dose was? Any other advice?

It's not that I don't trust my GP but she's here in a small town in rural Ireland and she says herself she doesn't know anything about tropical medicine.

Well, I've had flagyl pumped into me, half a litre a day if I remember! That was post operative, for the removal of a severely infected cyst --- it, along with the other couple of other antibiotics, was wonderfully effective: I felt almost sterile!

Google will probably lead you to manufacturer's details for the drug, and you may find recommended dosages. Similarly, you may find recommended doses by googling the disease. Some things require enormous dosages of anti-biotics, especially at the beginning of the treatment. As your doc admits she doesn't know tropical medicine, she probably looked it up!

Otherwise... is it possible for you to get to a tropical medicine specialist?

Usual dosage for metronidazole.

Oh, and I am not a doctor.

I had giardia many years ago. I was extremely weak, and it took them some time to find out what it was. Anyway, I was prescribed metronidazole, and as far as I remember it was just A SINGLE dose. I was fine from then onwards.

Giardia : 800 mg x 3 for at least a week ... I could probably recite that in the middle of the night - but I did check. One reason to reduce the dose could be related to body weight. For children the recommendation is 7.5 mg per kilo body weight.

Single dose antibiotics is a lottery , where the losing option is the bacteria or in this case protozo becoming resistant. This is esp. a risk when taking it orally , since you can have partial uptake from vomiting or diarrhea.

I was given it at a university hospital, institute of tropical medicine. But it was in the nineties. Things might have changed.

Thankyou for that vistet (and the other replies too). Can I ask what is your source of that information? Are you medically qualified yourself? Any information, such as recommended doses in other countries, is useful to me.

I phoned my GP yesterday to query the dose - because the pharmacist had thought it seemed too heavy, but then she'd probably never had anyone with giardia before either - and the GP said that the dose she'd put me on now (2g per day for 3 days) was what the microbiologist who tested the sample the first time had recommended AND what the books said, but that she, who has never had anyone with giardia before, thought it seemed too much and so she had put me on that lower dose the first time. (with the consequence that the giardia survived)

This makes me so angry - in effect what I've done is what we're always told not to do ie taken an incomplete course of antibiotics, because of an inexperienced GP.

vistet, you said it should be 2.4g per day for a week, and she's only prescribed me 2g per day for 3 days - I value your information, that's why it would be really useful to know its source.

Oh, why did I choose to live in a country that doesn't have such a thing ...

(I just saw a smiley I didn't know existed, so I'm going to use it as it is a symptom of giardia: fart! )

Just in case it takes Vistet a while to be back in here, from his posts he works as a nurse in Sweden yes (and, I think, regularly accompanies mountaineers in India et al., so is probably fairly up-to-speed with some tropical afflictions).

hello, so much confusion about giardia amuses me, it is soo common in india! that people generally learn to live with it here!

well the usual dose of metronidazole is 400mg 3 times a day,......but all dosages depends on body weight.

generally giardia in india are resistant to metronidazole in many cases, so wait for some time, and if u still have the same symptoms then change to some other medicine, like ornidazole or secnidazole.

also in india giardia comes with other mixed infections too, so a course of ciprofloxacin with metronidazole is preferred than giving it alone........may be u r still having symtoms due to mixed infections.

regards

tintin

Well, after my second round of flagyl (400mg, 5 times a day for 3 days) I think that I can report I'm finally getting better. The symptoms have gone and I just need to rebuild my strength and fitness now.

A couple of other points - it was recommended to me to avoid dairy produce while on flagyl and for 6 weeks afterwards so I'm doing that, and also having no fish (don't eat meat anyway) or alcohol or caffeine (apart from weak black Earl Grey tea) for the time being. It has also been suggested that I cut down on wheat - basically to avoid anything that is difficult to digest while my guts are recovering.
So I'm having a very healthy diet of fruit and veg, grains, pulses, nuts, eggs, herbal tea and the occasional treat of some dark chocolate.
I'm also taking a heavy duty probiotic.

It seems that giardia affects different people to different degrees - well it really knocked me for six.

I hope this info will be useful to someone!

Glad to hear you are better

There is another med for Giardia which is not available in the US, unsure about other countries like the UK, Aus, etc. It is Tinidazole, trade name Tiniba. I got it at a pharmacy in Nepal after I had been miserable for two weeks(able to walk around but diarrhea every AM, bloated, low grade nausea, weakness, general icky feeling but NO WEIGHT LOSS DAMMIT!), finally being diagnosed with Giardia. You take 4 500mg pills in one big dose instead of a longer course like with Flagyl and it completely knocked out the Giardia - after a day or so I was back to normal. No side effects either which I worried about, taking such a big dose.

Very true - as I said in my last post I had it 3 years ago and I was still able to function, however my friend got it in '08 and got so sick (vomiting) he had to go to the ER.

tinidazole 500mg as 4 tab stat i.e 2gm is not any recomended dose!

I was sceptic , but looked it up in the pharmaceutical handbook here : 2 grams single dose for giardia , and as pre-operative dose before abdominal surgery. This depends on actually knowing that it´s giardia , and only giardia : longer treatment time for amoebic dysentery , and may be needed to be complemented with another antibiotic against aerobic infection.