Treatment of Parasitic Diarrhea in Children

Dosage Recommendations

• The American Academy of Pediatrics recommends metronidazol 15 mg/kg/day divided into three doses for 5 days for the treatment of giardiasis in children 1
• The Infectious Diseases Society of America recommends metronidazol 30-50 mg/kg/day divided into three doses for 5-10 days for the treatment of Entamoeba histolytica infections in children 1
• The American Academy of Pediatrics recommends tinidazol 50 mg/kg as a single dose for the treatment of giardiasis in children aged 3 years and older 2

Treatment Algorithms

• The first-line treatment for giardiasis is tinidazol 50 mg/kg as a single dose (if the child is aged 3 years or older), or metronidazol 15 mg/kg/day divided into three doses for 5 days (if tinidazol is not available) 1, 2, 3
• If the initial treatment fails, consider an alternative course of treatment and consult with a pediatric infectious disease specialist 2, 4

Supportive Measures

• Emphasize hand washing after using the bathroom, before preparing food, and before eating 2
• Maintain adequate oral hydration, especially if diarrhea is present 2

Precautions

• Avoid administering antimotility agents (such as loperamide) to children under 18 years old with acute diarrhea 2, 4
• Avoid repeated or prolonged courses of metronidazol due to the risk of cumulative neurotoxicity 5

Giardia Treatment Guidelines for Children

Introduction to Giardiasis Treatment

• The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend metronidazole 15 mg/kg/day divided into three doses for 5 days as the treatment for giardiasis in children under 3 years, as tinidazole is only FDA-approved for children ≥3 years of age 6, 7

Treatment Options

• Metronidazole is the treatment of choice for children under 3 years, given at 15 mg/kg/day divided into three doses for 5 days, as recommended by the Centers for Disease Control and Prevention 8, 9, 10, 11
• A pediatric suspension of metronidazole can be compounded from tablets, according to the Clinical Infectious Diseases guidelines 6, 7

Diagnosis and Follow-Up

• Multiple stool examinations may be necessary as Giardia can be shed intermittently, as noted by the Clinical Infectious Diseases guidelines 6, 7

Medication Administration

• For a 1-year-old weighing 10 kg, the metronidazole dose is 15 mg/kg/day = 150 mg/day, divided into 3 doses: 50 mg three times daily for 5 days, as recommended by the MMWR Recommendations and Reports 8, 9, 10, 11