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Dr. Andrew Rynne

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Exp 50 years

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Feeling dizzy, vertigo, fatigue and contracted giardia lamblia. What treatment should be done?

Answered by
Dr. Ketan Vagholkar

Gastroenterologist, Surgical

Practicing since :1989

Answered : 883 Questions

Posted on Tue, 18 Dec 2012 in Infections
Question: Please forward this to an indian doctor.

Question 1: Hi, this summer I was on a one month trip in India. While there I contracted giardia lamblia wich I still have. I have taken one round of tinidazole, and my girlfriend have taken metronidazole. None of the two killed the parasite. The doctors here in Norway seems to know about nothing else than metronidazole.

How would an Indian doctor treat a stubborn case of giardia, what kind of medisine would you recommend, and what dosages. Should one combine some medisines?

Question 2: While in kerala I suddendly became violently ill, dizziness, vertigo, fatigue, distorted sight and numbness and tingling over the whole left side of my body including muscular weakness. Balance was wery bad. I have been examined and can rule out MS, stroke, nervedamage and meningitis/enchepalitis, although the answers has not come back yet regarding japanese enchepalitis. The doctors suspect something organic. Now over four months later the symptoms has faded, but are still lingering.

Do you know of any particular parasite, virus or disease in India that could cause these longlasting symptoms?


Answered by Dr. Ketan Vagholkar 4 hours later
Thanks for writing in.
For giardiasis you need to take a full course of a combination of
1.Tab Ciprofloxacin 500mgms twice a day.
2.Tab metronidazole 400mgms thrice a day
This conbination should be taken for a period of at least 21 days in view of the severity and chronicity of symptoms.
Tinidazole may at times may not work well for giardiasis.

Regarding the symptoms which you have described there are two possiblities.
1. Viral encepahalitis.
2. Neurovascular stroke.
3. Demyelinating disorders.

For the neurological disorders you need to undergo a MRI scan for diagnosis.
For viral encephalitis a CT brain, serological markers and CSF evaluation may be required.It is very difficult to pinpoint the virus responsible for such a disorder.

I hope this answewrs your querry.
With regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ketan Vagholkar 2 days later
Thanks for you answer.

I have some follow up questions:

1. Would it be prudent to take probiotics during the antibiotics cure?

2. I read somewhere that Indian giardia often comes together with other infections/parasites, is this true?

3. Can giardia be resistant to metronidazole/tinidazole etc?

Regarding the other illness. I have been tested with MRI, CT-scan, lumbar puncture with csf evaluation, eeg, ekg and emg and additional numerous blood samples. So far nothing has been found. Suggestions? I´m speculating if it could have been a mild case of japanese encephalitis.
Answered by Dr. Ketan Vagholkar 13 hours later
Thanks for the feedback.
1.Taking probiotics while on antibiotic therapy would not be of much help. In fact you should start probiotics after completion of the course of antibiotics.
2. Yes this is a possibility. therefore I had suggested a combination of metronidazole with ciprifloxacin which would cover most of the pathigens.
3. Unlikely but cases have been reported.
Since all the imaging investigations are normal you need not worry about the brain problem. However a physician opinion more so a neurologist opinion is advisable.
I hope this answers all your doubts.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ketan Vagholkar 36 minutes later
One last question. What kind of infections/parasites usually comes together with the giardia infection? Would it be useful to test for these?

Thanks for your answers.

Kind regards
Answered by Dr. Ketan Vagholkar 26 hours later
thanks for the feedback.
Organisms causing bacillary dysentry usually accompany giardiasis. A stool culture for organisms may help at times. But usually a long course (21 days)of the said antibiotics usually help in curing this problem.
I hope that answers your doubt.
With regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

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