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Giardia Lamblia treatment(xposted AT-L PCT-L)

I have received several comments critical of my previous post Giardia
Lamblia treatment. It  was intended to point out 2 things.

1) Tinidazol is a much better treatment for Giardia than Flagyl, and is
listed as "THE DRUG OF CHOICE" by the Center for Disease Control for
Giardiasis, and other intestinal parasites. It works as well without the
severe side effects comon to Flagyl, and with only one dose. Tinidazol is
not available in the USA, but is available in the Caribian and Mexico, very
near the southern end of the PCT. Also, a course of Tinidazol costs about
$0.50 as opposed to about $60 for Flagyl. The bad experiences that hikers
have had with Giardia medication are due to Flagyl, not tinidazol.

2) In the circumstances prevalent along the PCT and to a lesser extent the
AT, the hiker may be several days from the nearest town, and many of the
smaller towns have no doctors, which would require begging a ride to the
nearest town with one. Assuming it's not a weekend, this would still require
several miserable days of travel to seek treatment. In this situation, self
diagnosis, and treatment may be a better choice for the informed and
competent through hiker. This does NOT mean swallowing some pills at the
first loose stool. If you are not comfortable evaluating yourself, and don't
have enough confidence in your own judgement, then by all means don't even
consider this.

In general, tests for Giardia are often inconclusive, so if your symptoms
are appropriate, and you have been exposed, the doctor will most likely
presumptively treat you for Giardia, having first examined you for more
serious illnesses. Thinking that a more serious illness "only Giardia" is
probably the biggest risk of self treatment. If you experience sudden acute
abdominal pain, accompanied by a fever, you don't have Giardiasis. Get
medical attention ASAP--Send someone out to get it!

Giardiasis itself will not kill you, but dehydration from severe diarrhea
could. It is important to keep hydrated in this circumstance with an
appropriate electrolyte drink like Oral Rehydration Solution, Pedialyte or
Gatoraide. Water alone will not work, and can lead to other fatal problems. 

A very good reference for the health concerns of trekker's is "Trekking in
Nepal" 6th edition, by Stephen Bezruchka, MD (The Mountaineers Books
800-553-4453) Although the USA is a more benign environment than Asia, many
of the same medical concerns of trekking in Nepal apply to the through hiker.

To quote from "Trekking in Nepal"

"What follows may seem frightening to would-be trekker's who are used to the
professional medical care available in modern society. In Nepal you may be a
weeks walk, or more, from a doctor...Awareness and prevention are the keys.
But it is better to have advice available should it be needed, rather than
to disclaim any potential for illness, and to avoid liability on my part."

"If your diarrhea is accompanied by burps of rotten-egglike gas, then the
protozoan parasite Giardia lamblia may well be the cause...It generally
takes a longer time to acquire this infection than the bacterial ones,
usually two weeks, and sometimes longer, after ingesting the cysts. Stools
will often contain mucus and smell like rotten eggs or sulfur, as will
expelled gas. Trekker's presenting at clinics with diarrhea for two weeks or
longer are more likely to have Giardia. If your symptoms persist for several
days, and you are far from help, it makes sense to treat yourself
presumptively for giardiasis. Take 2 grams of tinidazole as a single dose.
The dosage may have to be repeated in 24 hours. Some trekker's have
developed Giardia neuroses, thinking that each loose stool has been caused
by this comical-looking flagellate. There are other causes of loose stools
and foul-smelling burps. For these people, taking tinidazole every few days
could be risky."

I feel that the through hiker should be as educated a possible about the
things that may happen to him (or her) on a long trek, and I am presenting
this information in that spirit. I know it goes against our current societal
wisdom, that the individual should rely on others to take care of him, but
after all, isn't self-reliance and self-responsibility part what we seek on
a long trek?

disclaimers apply. I am not a doctor, and I am not giving medical advice,
just attempting to educate and entertain. I am only providing the reader
with references to sources which he might find usefull.

Brick Robbins                  "go fast enough to get there,
San Diego, CA                   but slow enough to see"
brick@ix.netcom.com             ---Jimmy Buffett