Travel Medicine / Vaccination / Immunization Expert Forum
treatments for parasites
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Questions in the Travel Medicine forum are answered by Dr. Philip D Parks, affiliated with Harvard School of Public Health. Topics covered include disease prevention, finding a doctor abroad, food and water safety, illness and injury abroad, mosquito and tick protection, resources for travelers, traveling with children or pets, traveling with special needs, vaccinations and immunizations.

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treatments for parasites

A few years back I traveled to SE Asia (Thailand, Cambodia, Vietnam) and then a couple of years later to India.

When I was pregnant, I discovered that in one of the places I picked up a parasite called Blastocystis Hominis (sp?) --  I took a 10 day course of Flagyl (which was the most vile medicine I have ever taken).

I have concerns that the Flagyl didn't work and I still have this parasite.  I plan to get tested again but I want to know if there is any alternative treatment to the Flagyl?   It was so bitter and even wrapping it in bread didn't help mask the taste....also, I am pregnant with my second child so that needs to be considered when recommending a treatment.

Any suggestions would be appreciated --
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Avatar_dr_m_tn
Dear mommyqs,

There is intense debate in the medical literature as to whether blastocystis hominis causes disease in humans. B. Hominis is found commonly in diagnostic testing along with other parasites that do cause disease (for example, giardia, entamoeba histolytica.  And, sometimes, the using medication (such as Flagyl) is ineffective at eradicating the parasite from patient's intestines. There are some parts of the world where Flagyl resistance is quite common (for example, India).

What kind of symptoms are you currently having? I realize that this question may be a bit personal and that your answer may be a bit graphic. Have you been tested for the presence of B. hominis in your stool? As I mentioned above, even if b.hominis is present in your stool, it may not be the cause of your symptoms.

Alternative treatments to Flagyl include:
1. Iodoquinol (also called Yodoxin) 650 mg three times daily for 20 days (Pregnancy Category C)
2. Trimethoprim-sulfamethoxazole 1 DS (double strength) (also called Bactrim)
tab twice daily for 7 days (Pregnancy Category C) * there are specific contra-indications that discourage use of Bactrim during pregnancy and while breastfeeding.

*Flagyl is contraindicated during the first trimester of pregnancy.

Pregnancy Categories:
http://www.fda.gov/fdac/features/2001/301_preg.html

Current Categories for Drug Use in Pregnancy
Category Description
A Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities.

B Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate and well-controlled studies in pregnant women; or Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus.
C Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in pregnant women; or
No animal studies have been conducted and there are no adequate and well-controlled studies in pregnant women.
D Studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk.
X Studies, adequate well-controlled or observational, in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. The use of the product is contraindicated in women who are or may become pregnant.

Blastocystis hominis: http://www.cdc.gov/ncidod/dpd/parasites/blastocystishominis/factsht_blastocystis_hominis.htm


~Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.
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