Recurrent giardial infection in children with non symptomatic giardiasis ofter treatment with metronidazole should it be treated?

Background and Giardial intestinal infections are the most common diseases in children. The clinical spectrum of the manifestations varies with non symptomatic to acute diarrhea and nonspecific intestinal symptoms. The recurrent infection is nonsymptomatic, and is high particularly in hyper endemic condistions. Ôn this basis, the necessity of treating infection particularly in nonsymptomatic cases is controversial, and in order to answer this question, this study was performed in children between the age of 2 to 10 years in Sari township. This study was a clinical trial done on 405 children from kindergardans and primary schools of Sari township without any intestinal complication in the last one month. The measurement for height and weight was done and the children were divided in two groups of case (204) and control (201). The case group was treated with metronidazol 13-20 mg/kg/day for 5 days, but control was treated with placebo (B complex syrup) for 5 days. Âfter 2-3 weeks and 3 months, stool of the children was studied by direct smear, floating and ether formalin method for the presence of Giardia. Statistical analysis was done by X2 test. Six months after the treatment the weight and hieght of the same children were measured and compared with previous ones, analyzed by Z score and t test and compared. Âfter two to three weeks, from the case group 30 (16%) children and after another 3 months 60 (29.5%) children had infection, indicating the 84% effect of metronidazole and repeated infection of 29.5% in three months period. Ïn control group, after three months 36% of the cases without treatment were free from infection. (self elimination). The chance of reinfection with relative threatening of 1.89 and P<0.01 was significant. Self elimination with X2=8.81 and P<0.01 was significant. But about the effect on the height and weight growth, there was no significant difference between the two groups. Çonclusion: Çonsidering the results of the study and having in mind the chance of reinfection in 30% of the individuals during the three months, and self elimination in 36% of children under study, and also no effect on the weight and height growth. Ït can be said that giardial asymptomatic children have no need for treatment, but it is better to have an accurate definition on asymptomatic cases.