Gentamicina

A Meta-analysis of the Effectiveness of Albendazole Compared with Metronidazole as Treatments for Infections with Giardia duodenalis
Shahram Solaymani-Mohammadi1*, Jeanine M. Genkinger2, Christopher A. Loffredo2, Steven M. Singer1*
1 Department of Biology, Georgetown University, Washington, D. C., United States of America, 2 Department of Oncology, Lombardi Cancer Center, Georgetown UniversityMedical Center, Washington, D. C., United States of America

Abstract
Background: Metronidazole is the most commonly used drug for the treatment of giardiasis in humans. In spite of its therapeutic efficacy for giardiasis, low patient compliance, especially in children, side effects, and the emergence of metronidazole-resistant strains may restrict its use. Albendazole has been used to treatGiardia duodenalis infections in recent years. However, efficacy studies in vivo and in vitro have produced diverse results as to its effectiveness. A moderately benign side effect profile, combined with established efficacy against many helminths, renders it promising for treatment of giardiasis in humans. Methodology and Principal Findings: We performed a search in the PubMed, Scopus, EMBASE,the ISI Web of Science, LILIACS, and Cochrane Controlled Trials Register for trials published before February 2010 as well as in references of relevant research and review articles. Eight randomized clinical trials (including 900 patients) comparing the effectiveness of albendazole with that of metronidazole were included in meta-analysis. After extracting and validating the data, the pooled riskratio (RR) was calculated using an inverse-variance random-effects model. Albendazole was found to be equally as effective as metronidazole in the treatment of giardiasis in humans (RR 0.97; 95% CI, 0.93, 1.01). In addition, safety analysis suggested that patients treated with albendazole had a lower risk of adverse effects compared with those who received metronidazole (RR 0.36; 95% CI, 0.10,1.34), but limitations of the sample size precluded a definite conclusion. Conclusions/Significance: The effectiveness of albendazole, when given as a single dose of 400 mg/day for 5 days, was comparable to that of metronidazole. Patients treated with albendazole tended to have fewer side effects compared with those who took metronidazole. Given the safety, effectiveness, and low costs ofalbendazole, this drug could be potentially used as an alternative and/or a replacement for the existing metronidazole therapy protocols in the treatment of giardiasis in humans.
Citation: Solaymani-Mohammadi S, Genkinger JM, Loffredo CA, Singer SM (2010) A Meta-analysis of the Effectiveness of Albendazole Compared with Metronidazole as Treatments for Infections with Giardia duodenalis. PLoS Negl TropDis 4(5): e682. doi:10.1371/journal.pntd.0000682 Editor: Jennifer Keiser, Swiss Tropical Institute, Switzerland Received August 21, 2009; Accepted March 25, 2010; Published May 11, 2010 Copyright: ß 2010 Solaymani-Mohammadi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction inany medium, provided the original author and source are credited. Funding: This study was supported in part by a merit-based scholarship from the Georgetown University Graduate School of Arts and Sciences (SSM) and partially by the NIH/NIAID grant R03-AI-081033(SMS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Competing Interests: The authors have declared that no competing interests exist. * E-mail: ss759@georgetown.edu (SSM); sms3@georgetown.edu (SMS)

Introduction
Giardiasis in humans, caused by the protozoan parasite Giardia duodenalis (syn. G. lamblia, G. intestinalis), is a common parasitic disease [1]. The prevalence of infection is commonly between 2– 5% in the developed world and 20–30% in the...