Emerging Issues in Managing Pediatric Parasitic Infections: An Assessment of Clinical and Epidemiological Knowledge of Giardiasis and Cryptosporidiosis

Abstract

Background: We are not aware of any survey data that has assessed the general awareness by pediatricians of Giardia and/or Cryptosporidium infection, the most common causes of human intestinal parasitic infections in the United States. The aim of this survey was to evaluate pediatrician knowledge and perceptions on the treatment of parasitic infections in children 1-12 years of age. Methods: A 44-question online survey was conducted from July 1 to July 14, 2014 among 1000 pediatricians. Results: Almost all respondents identified viruses as the most likely cause of diarrhea (95.0%) in young patients and therefore reported treating with supportive therapy (82.4%). Approximately only 10% of respondents would suspect parasites if the diarrhea became persistent, with the duration of persistence generally considered as more than 1-2 weeks. If they considered parasites as the cause of diarrhea, they would most commonly test for both Cryptosporidium and Giardia, and initiate therapy after confirmation (70.9%). The drug of first choice for empiric therapy was most commonly metronidazole (78.4%) followed by paromomycin (10.4%) and nitazoxanide (6.4%). Notably, 72.0% of pediatricians considered the availability of nitazoxanide would change their potential treatment choice for diarrhea. Respondents preferred additional print materials (56.2%) followed by live events including web-based education (35.6%) to receive additional education concerning parasitic infection in children. Conclusion: This survey supports the need to enhance efforts to provide education among pediatricians on how best to manage and treat childhood diarrhea caused by parasites such as Giardia and Cryptosporidium.