***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Giardia lamblia is a flagellate protozoan that produces symptoms by infecting the small bowel and biliary tract in the trophozoite form . Diagnosis is currently established by microscopic visualization of the organism in appropriate intestinal contents ( stool , small-bowel contents , or biopsy specimen ) . Adult patients with diarrhea and one or more enteric symptoms may be enrolled in clinical trials of new drugs for the treatment of giardial disease . A r and omized , double-blind , active-concurrent-control design is recommended . Post hoc stratification by age , immune status , chronicity of disease , and ease of establishing diagnosis ( organism load ) may be performed . Microbiological assessment 48 hours to 7 days after the completion of therapy is paramount for determining final outcome Fifty-five patients , 51 males and 4 females heavily infected with Giardia lamblia were treated with a single 2 g dose of tinidazole ( four tablets ) ; 53 were cured . Of 20 other infected patients kept under the same conditions and given four placebo tablets , 18 continued to pass cysts or trophozoites in the stools during the whole 3- to 4-wk follow-up period in hospital . There were no side effects attributed to the drug One hundred children were entered into a r and omized study to compare the efficacy and safety of furazolidone and metronidazole when given in liquid suspension for treatment of giardiasis . The study was conducted between May 1985 and February 1986 . Dosages were calculated on the basis of body weight , and treatment lasted 10 days . Clinical diagnosis of giardiasis was confirmed by the presence of Giardia cysts in stools . Children were excluded from the study if stool culture was positive for pathogenic bacteria . Eighteen of the 100 children were withdrawn from the study because of noncompliance with the protocol . Of the 82 remaining patients , 37 received furazolidone and 45 metronidazole . No statistically significant differences in efficacy between treatments were found . With the exception of one case of urticaria , which occurred in a patient who received metronidazole , both drugs were well tolerated . In this study , furazolidone and metronidazole were equally safe and effective in treating children with giardiasis The therapeutic effects of quinacrine ( Atabrine ) and metronidazole ( Flagyl ) were compared in a 3-year prospect i ve study of 160 infants and children ( 86 boys and 74 girls ranging in age from 4.5 months to 13 years ) with giardiasis . The most common symptom was recurrent abdominal pain . In each study group stool examinations were done 5 days , 1 month , and 6 months after treatment . There were no treatment failures with metronidazole , whereas four of those treated with quinacrine had positive stools 5 days after treatment , indicating possible failure . There were no recurrences at 1 month ; after 6 months , however , Giardia infection was found in 13 % of both treatment groups . These recurrences were seen mainly in children from families with other infected members . Considering the low failure rate , the minimal side effects , and the relatively more tolerable flavor , metronidazole seems to be preferrable in the treatment of giardiasis . A dosage of 15 - 25 mg/kg a day for 5 days is recommended 50 patients with giardiasis were treated with either metronidazole or tinidazole in r and om order according to a code . 25 patients received 2.0 g metronidazole on 2 consecutive days ; 19 were cured ( 76 % ) ; 7 patients complained of mild side-effects . 25 patients received tinidazole 2.0 g as a single dose , and 22 were cured ( 88 % ) ; 5 patients complained of mild side-effects . The difference between the results of the two regimens was not statistically significant . A 1-week course of metronidazole ( 200 mg 3 times daily ) was successful in 8/9 failures ; 1 patient was finally cured with mepacrine This study describes a prospect i ve , r and omized , clinical trial in patients infected with the protozoa Giardia lamblia . Patients received a 10-day treatment with twice a day doses of either 120,000 U ( USP ) of bacitracin zinc , 120,000 U ( USP ) of bacitracin , 120,000 U ( USP ) of neomycin , or 60,000 U ( USP ) of bacitracin zinc and 60,000 U ( USP ) of neomycin . At the first assessment ( day 11 ) , all 21 subjects ( 100 % ) treated with bacitracin zinc had ceased to show Giardia parasites in their stools compared with 19 ( 95 % ) of 20 receiving bacitracin , 20 ( 90.9 % ) of 22 subjects receiving neomycin , and 17 ( 89.5 % ) of 19 subjects receiving bacitracin zinc plus neomycin . During the two-week follow up period , one ( 5.3 % ) of the 19 subjects examined who received bacitracin zinc experienced a recurrence compared with one ( 6.7 % ) of 15 receiving bacitracin , one ( 5.0 % ) of 20 receiving neomycin , and 0 ( 0 % ) of 14 receiving the combination treatment . Final cure rates of 94.7 % for bacitracin zinc , 87.5 % for bacitracin , 86.4 % for neomycin , and 87.5 % for bacitracin zinc plus neomycin were obtained . No synergistic activity was noted between bacitracin zinc and neomycin .  Side effects were generally limited to nausea , abdominal discomfort , and diarrhea in a small number of patients This study was design ed to compare the treatment efficacy of single dose of ornidazole with 5 d treatments of ornidazole and metronidazole in children with giardiasis . 175 children , between 2 and 15 y old , whose stool sample s were found to be positive for Giardia lamblia cysts and /or trophozoites by either saline-Lugol , formalin-ethyl acetate or trichrome staining , were enrolled in the study . Of these children , 105 were treated with a single dose of  ornidazole : 35 with 30 mg/kg , 35 with 25 mg/kg and 35 with 20 mg/kg ; 35 were treated with 25 mg/kg per day of ornidazole for 5 d in 2 doses and 35 children were treated with 20 mg/kg per day metronidazole for 7 d in 3 doses . All cases were examined on the 7th , 10th and 14th days after treatment by the same methods ; clinical symptoms were also evaluated . Giardia lamblia was eradicated in 34 of 35 ( 97 % ) , 34 of 35 ( 97 % ) and 33 of 35 ( 94 % ) patients treated with 30 , 25 and 20 mg/kg single doses of ornidazole , respectively . Eradication was achieved in all 35 patients treated with 25 mg/kg per day ornidazole for 5 d and in 31 of 35 ( 89 % ) patients treated with metronidazole . There was no statistically significant difference among doses of ornidazole ( p > 0.05 ) ; however , all ornidazole treatment regimens were significantly more effective than  metronidazole treatment ( p < 0.05 ) . No important side-effects were detected in any patients and clinical symptoms disappeared in all . Single-dose ornidazole treatment could be considered as a proper and effective alternative method for the treatment of giardiasis in children Giardiasis and soil-transmitted helminthosis are prevalent in many parts of the world . Application of a single drug for treatment of both giardiasis and soil-transmitted helminthosis is highly desirable . One hundred children of both sexes , ranging from 7 to 12 years old with Giardia intestinalis cysts or trophozoites in their stool sample s , were r and omly separated into two groups of 50 individuals each . Each group received either mebendazole tablets 200 mg thrice daily for 5 days or metronidazole tablet 15 mg/kg/day in three divided doses , for 7 days . The results were evaluated by microscopic examination of stools on two successive occasions : 1 week and 2 weeks after treatment . Each occasion consisted of three stool examination on 3 successive days . The cure rate of mebendazole-treated children was 43 out of 50 ( 86 per cent ) , and for metronidazole it was 45 out of 50 ( 90 per cent ) with no statistical difference between the two groups . No side-effects were observed in the mebendazole-treated group , whereas nausea , anorexia and metallic taste were observed in 4.9 , 6 and 24 per cent of metronidazole-treated children , respectively . In conclusion , the use of mebendazole , which is less toxic with no side-effects , is available and effective on Giardia intestinalis as well as intestinal nematodes , is recommended especially in the areas where giardiasis and intestinal nematodiasis are prevalent and overlap Sixty-three expatriate residents and travellers in Bangladesh , infected with Giardia lamblia , participated in two studies to compare the therapeutic efficacy of tinidazole and metronidazole . In the first trial 33 r and omly selected patients were treated with tinidazole ( 50 mg/kg of body weight to a maximum of 2 g ) or metronidazole ( 60 mg/kg of body weight to a maximum of 2.4 g ) in a single oral dose . Patients were followed for 4 weeks after the end of therapy for the presence of G. lamblia in their stools . Sixteen ( 94 % ) of 17 patients receiving tinidazole were free of G. lamblia during that period , compared to only 9 ( 56 % ) of 16 patients who had received metronidazole ( P less than 0.02 ) . In the second trial patients were r and omly allocated to a treatment schedule of either metronidazole as a single dose on 3 successive days ( 50 mg/kg of body weight to a maximum of 2 g daily ) or tinidazole as a single oral dose ( 50 mg/kg of body weight to a maximum of 2 g ) . All 15 patients treated with tinidazole and 14 ( 93 % ) of 15 patients treated with metronidazole were free of G. lamblia during the 4-week follow-up period . A single oral dose of tinidazole is a highly effective treatment for giardiasis and is equal in efficacy to a 3-day therapy with metronidazole Enteric infection by Giardia intestinalis is a common cause of diarrhoea world‐wide and a significant cause of morbidity in children One hundred children suffering from symptomatic giardiasis were treated with either tinidazole or metronidazole in r and om order . Both the drugs were given as a single oral dose calculated on the basis of 50 mg/kg body weight . Parasitological and clinical cure was obtained in 40 ( 80 % ) of 50 patients given tinidazole and in 18(36 % ) of 50 patients given metronidazole . This difference in cure rates was significant ( p less than 0.01 ) . Furthermore , control of diarrhoea and negative stool conversion for G. lamblia were achieved earlier with tinidazole than with metronidazole , the differences being significant ( p less than 0.01 ) from the 8th post-treatment day . Gastro-intestinal side-effects of mild degree occurred in 6 patients on tinidazole and in 2 patients on metronidazole ; they comprised nausea , vomiting , and bitter taste . Neither drug caused any abnormal deviation in blood counts or in biochemical tests of liver and kidney function Between July and October 1987 an outpatient study of 191 children with acute diarrhea was undertaken in two rural communities in Mexico . Through a double-blind r and omization we compared the efficacy of a combination therapy of furazolidone , 7.5 mg/kg/day , plus st and ard oral rehydration therapy ( ORT ) ( 96 patients ) versus a placebo plus ORT ( 95 patients ) , each given for 5 days . Diarrheal stool sample s were collected from all patients before therapy . By means of a two-vial transport media system the sample s were sent to a university laboratory and examined for viral , bacterial , and parasitic organisms . The most commonly isolated organisms were enterotoxigenic Escherichia coli ( 13 % ) and Giardia lamblia ( 13 % ) . Patients who received furazolidone plus ORT showed a greater reduction in duration of diarrhea when compared with those receiving placebo plus ORT ( 63.4 h versus 71.44 h ) . There was also a trend toward shorter duration of diarrhea in patients with Giardia who were treated with furazolidone/ORT  compared with Giardia patients in the placebo/ORT  group . When fecal leukocytes were present in the stool , the furazolidone/ORT-treated patients had a significantly higher percentage of clinical cures ( 79 % versus 
    Output:
    
REVIEW ER 'S CONCLUSIONS A single dose of tinidazole appears to give the highest clinical cure rate for giardiasis with relatively few adverse effects