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INFECTIONS SPREAD AT SCHOOLS, DAY-CARE CENTERS

Q: My 2-year-old daughter was diagnosed with giardiasis, but was given no medication. She was first prescribed Furoxone, but when we went to get it filled, we were told it was no longer available. I'm concerned that this will be an ongoing problem for my daughter now. Should I believe that no treatment is required after the first option became unavailable, or should I go to another doctor?

-- L.K.

A: I don't blame you for being concerned. It has to be frustrating to have a sick child and feel you're not getting help with the problem.

Giardiasis is the most common parasitic infection of the small intestine in children. It is caused by the single-celled parasite, Giardia lamblia. Transmission of the parasite can occur both directly, e.g., feces to hand to mouth, and indirectly, such as from contaminated food or water.

Children are particularly at risk in an institutional setting such as school. Day-care centers are a major source of infection for younger children; in some centers, an infection rate of 50 percent of the children has been reported. Proper disposal of diapers and frequent hand washing by staff should hold down infection.

As you may know, early symptoms include nausea, gas, abdominal discomfort, bulky stools and diarrhea. As the disease progresses, symptoms can include chronic diarrhea and lack of weight gain in children (weight loss in adults). This is due to a lack of absorption of nutrients by the small intestine.

The symptoms can often suggest the diagnosis, but laboratory exams of stool samples will verify the presence of G. lamblia. The condition usually lasts more than a week, but can continue for months until the medication takes effect, or when the infestation spontaneously goes away.

People with giardiasis who show definitive gastrointestinal symptoms should be treated. Treatment for people, especially children, who don't have symptoms is more controversial. Many feel treatment for these people is important, if for no other reason than to hold down the transmission of infection to others.

Still, the antimicrobial drugs used to treat this infection are strong and have side effects. Many health-care providers are reluctant to prescribe such medication for children, especially as young as your daughter.

Metronidazole is usually the drug of choice for this infection. It is an effective treatment with few side effects, and is well tolerated in children.

Doses of up to 250 mg (depending on body weight) three times a day for five days have a success rate of 80 to 90 percent.

Furazolidone (Furoxone) is often the first drug tried in children because it comes in a liquid suspension for easy dosing. The efficacy rate of furazolidone at the appropriate dose is around 80 percent. It does have side effects, including gastrointestinal upset.

Two effective drugs for giardiasis are not available in this country -- tinidazole and quinacrine.

Some patients fail to get better on one drug, or suffer relapse. A second or third course with the same drug or switching to another one is the usual next step.

If your daughter is in discomfort because of her symptoms, or if the symptoms of the infection happen over and over again, I recommend that you ask the doctor about treatment with metronidazole and other options open to her. If you don't get straight answers, you might want to see another doctor.

Update on smoking: Pneumonia is one of the leading causes of death, along with heart disease and cancer. And they all have one thing in common -- they are greatly increased in people who smoke.

A study just published in the medical journal Chest found that half the people who had pneumonia were smokers. This indicates that smokers have nearly three times the risk of getting pneumonia.

The good news is that five years after quitting smoking, the risk is only slightly higher and there is no increased risk after 10 years. I hope the haze is clearing for you.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is DRFamily@aol.com.

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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