[pct-l] anti-protozoals

Kristin Hamann aggie03.kh at gmail.com
Tue Mar 12 17:13:09 CDT 2013 

I am a veterinarian with a PhD in Basic Medical Sciences.  I cannot legally
diagnose or treat people, but I can do so in every other species.  I treat
gastroenteritis and giardia on a regular basis and can share some
information and my plan, but please do not interpret this as medical
advise.

   - The concern of most hikers is giardiasis, but in reality you are
   treating gastroenteritis.  I have known people that were treated for
   "Giardia," but there are relatively few cases of confirmed (by fecal exam
   and/or PCR) Giardia in people in the U.S., although it certainly does
   exist.  Giardia does not cross species lines well, and you will probably
   not get it from animals.  There are reports where beavers were infected
   with human Giardia and then infected people, but this is not common.
    Giardia has an incubation period of 1-3 weeks.  If you get sick the day
   after consuming unfiltered water, it is probably not Giardia.  Most cases
   of gastroenteritis will resolve because or in spite of what you take,
   although giardiasis may not.  Cryptosporidium is usually self-limiting
   unless you are immunocompromised.
   - Bleach and iodine are not very effective at killing Giardia, but they
   are pretty good for bacteria.  Chlorine dioxide (i.e. Aquamira) is pretty
   effective against giardia, as is filtration (see CDC link below on water
   treatment).  I worry more about bacteria than Giardia.
   - Metronidazole (flagyl) is effective against Giardia, anaerobes such as
   Clostridium, and has anti-inflammatory effects on the GI tract.  All good
   for gastroenteritis.  It is not effective against viruses like Norovirus;
   you are relying on tincture of time.  But the anti-inflammatory effects of
   metronidazole are probably beneficial and will also prevent clostridial
   overgrowth which can occur when your GI tract is out of wack.
   - In the U.S., metronidazole is generally first line treatment for
   gastroenteritis/suspect giardiasis (most of these cases are probably not
   Giardia).  Tinadazole is FDA approved but its use is more common in other
   countries where giardiasis is more prevalent.  Tinadazole does not have as
   broad spectrum as metronidazole.  I don't plan on carrying tinadazole, but
   we all make our own decisions.
   - I will be carrying metronidazole (I cannot legally supply this to
   people so please do not ask me to; not trying to be a jerk just I need my
   license to practice).  I suspect anyone who sees their doctor prior to the
   trip can get a prescription, or you could see about picking some up in
   Mexico.  I wouldn't do the fish stuff.  The stuff your vet gives your dog
   is actually a human medication used off-label in your dog.
   - If you don't carry metronidazole or tinadazole, consider carrying
   Immodium.  It's OTC and good for treating diarrhea; won't treat the
   underlying cause, but most cases of gastroenteritis are self-limiting.
   - Metronidazole and timadazole impair your body's ability to process
   alcohol.  The end result is an extra-bad hangover.  Alcohol also dehydrates
   you.
   - Be mindful of your hydration status and drink extra water.  If your
   gums feel tacky/sticky you have lost 5% of your body weight in dehydration.
    For a 150# person this means you are about a gallon behind on fluids.  If
   you are sick enough get off the trail to take care of yourself!  With very
   severe gastroenteritis IV fluids may be necessary.

http://www.cdc.gov/parasites/giardia/gen_info/index.html

http://www.cdc.gov/healthywater/drinking/travel/backcountry_water_treatment.html

Happy hiking!

Dr. k

On Tue, Mar 12, 2013 at 1:36 PM, Martin M. Clark
<martin.m.clark at gmail.com>wrote:

> David,
>
> Thanks for sharing this information! I'd just like to add that I am not a
> doctor, though I'm currently applying to med school as a 29 year old, but
> did look up the dosing instructions from web ms and they recommend 500mg 2
> x a day for 7 days.
>
> I would also like to say that the tests are very expensive and often ERs
> and doctors offices are crowded and take a while ti get an appointment!
> I'll be taking my chances with the fish zole. Better than shitting your
> pants in a grocery store  like my friend did on the at when he had giardia!
>
> Happy trails!!!
>
> Martin M. Clark
> 804-334-2009
>
> On Mar 12, 2013, at 12:29 AM, David Thibault <dthibaul07 at gmail.com> wrote:
>
> >>
> >>
> >
> >
> > I agree with wondering bob - but if your doctor is unwilling you can
> > always go the fish route.
> >
> >
> http://shopping.yahoo.com/836374708-fish-zole-metronidazole-250mg-60-tablets/
> >
> >
> > It's a weird country where you can't buy something for one use but are
> > allowed to buy the same thing for another use.
> >
> > Note: I've never used the Fish treatment option as I've always gotten my
> > Metronidazole from my doc, well actually once I used some left over from
> my
> > dog's medication but that is just cause I didn't feel like heading to the
> > doc's when I knew what I had and had the meds already in hand.
> >
> > I don't recommend self medicating but I've had giadia 3 times and by now
> I
> > know the symptoms very well.
> >
> > Day-Late
> >
> >
> >>
> >> Message: 34
> >> Date: Mon, 11 Mar 2013 09:07:34 -0700
> >> From: "Bob Bankhead" <wandering_bob at comcast.net>
> >> Subject: Re: [pct-l] anti-protozoals
> >> To: "'Martin Clark'" <martin.m.clark at gmail.com>,
> >>        <pct-l at backcountry.net>
> >> Message-ID: <005d01ce1e72$8b514ff0$a1f3efd0$@comcast.net>
> >> Content-Type: text/plain;       charset="us-ascii"
> >>
> >> Go to your doctor. Tell him what you're doing, and ask for a
> prescription.
> >>
> >>
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