Guardiasis in Paradise

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Of course, the best way to break the fecaloral cycle of infection is to practice good personal hygiene habits. Make sure all the members of your family wash their hands carefully with soap after toileting and handling diapers or other fecally soiled materials. And don't overlook pets or even yourself (you could be asymptomatic) as carriers.

TREATMENT

Giardiasis is treated with one of three drugs (prescribed by a doctor after diagnosis):

Quinacrine hydrochloride (brand name Atabrine): This quinine-based drug is now considered the most effective treatment.

Metronidazole (brand name Flagyl): The FDA regards this as an "investigational" drug for giardiasis.

Furazolidone (brand name Furoxone): As the only anti-giardiasis drug available in suspension, this one is useful for infants.

One course of treatment usually eradicates the organisms, although resolution may be slow. In my case, the doctor prescribed quinacrine hydrochloride, but warned me it would have nasty side effects. "What side effects?" I asked. "Nausea." But I already had that!

My cure was immediate. For me, the quinacrine was a real miracle drug . . . and was I thankful for it.

BACKCOUNTRY PROTECTION

How can people camping in the wilderness, traveling abroad, or even just living at home make sure the water they're drinking is safe?

Treatment with chemicals is not reliable. There are too many resistant organisms and critical variables (such as temperature, dosage, exposure time, and percentage of organic matter in the water). Consequently, neither chlorine nor iodine—two of the most common backcountry water purifiers—is 100% effective against giardia cysts. In addition, iodine is itself tricky to use and, indeed, potentially toxic. Accidentally swallowing a crystal or inhaling its gaseous fumes in a closed tent could cause serious illness. Chlorine, too, has drawbacks other than its partial effectiveness. It can form dangerous byproducts . . . and it definitely makes water taste bad.

Boiling will kill giardia cysts. A rolling boil will knock out giardias, other protozoa, and bacteria (not viruses, however). But boiling is inconvenient, time-consuming, and fuelwasting. (When I backpack, I don't bother much with fires or stoves anymore. I take dried foods-simple fare that will allow me to stay out for weeks at a time.)

For me the answer is the Katadyn pocket filter. It weighs 23 ounces, is about the size of a flashlight, and pumps water through a special ceramic filter whose maximum pore size is .2 microns. All particles and pathogens larger than this (including all protozoa and bacteria and some viruses) are physically prevented from passing through the filter. It's elegant, quick (it takes about three minutes of pumping to purify a quart of water), easy to use, and doesn't affect the taste. If the Katzdyn gets clogged with fine silt, the filter is easily cleaned with the stiff brush provided. This procedure can be repeated hundreds of times.

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