Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Jameson JL, et al., eds. Nitazoxanide is the first new drug developed for treating giardiasis in more than 20years. Make sure kids wash their hands after touching animals and going to the bathroom. Last reviewed by a Cleveland Clinic medical professional on 08/24/2022. Make a donation. CDC guidelines recommend the initial use of oral rehydration therapy with replacement of continuing fluid losses in children with mild to moderate dehydration. Expert Rev Anti Infect Ther. Yes 1, 2. Site of Infection and Pathogenesis. Treatment of cryptosporidiosis: nitazoxanide yes, but we can do better. Symptoms of cryptosporidiosis. You can get cryptosporidiosis from: There are lots of different ways to get cryptosporidiosis, but the main cause of infection is usually from drinking contaminated water or getting water in your mouth at a lake, pool or other public swimming area. Unauthorized use of these marks is strictly prohibited. Epub 2014 Feb 24. Dont swim in public pools or have sex for two weeks after having diarrhea. Would you like email updates of new search results? Thank you for taking the time to confirm your preferences. Take metronidazole exactly as prescribed by your doctor. He or she may also check your mouth and skin for signs of dehydration. Cryptosporidium is a Particularly Challenging Type of Coccidia for Pets. Metronidazole systemic 500 mg (PLIVA 334). You also may be given instructions about how to bring in a sample of your stool. and transmitted securely. Disclaimer. The dormant (inactive) form of Cryptosporidium , called an oocyst . Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. In: Harrison's Principles of Internal Medicine. Being cautious in places where Cryptosporidium is found and practicing good handwashing and food prep habits are the best ways to reduce your risk of cryptosporidiosis. Seasonal incidence showed that the highest rate was in winter (74.6%) while the lowest one was in autumn (7.1%). Giardia infection occurs worldwide in most domestic and wild mammals and many birds. Outbreaks can be declared by local, county, state, or national agencies; reporting outbreaks to the CDC is left to the discretion of the agency. Stool microscopy is rarely diagnostic, but the presence of red and white blood cells may signal a colonic source.4 Its primary use is identification of ova, cysts, and parasites, although antigen testing is more sensitive and specific for Giardia. However, it is not effective in severely immunocompromised patients and there is limited data in infants. If you have cryptosporidiosis, avoid eating or drinking anything that makes diarrhea and dehydration worse, like alcohol and caffeine. The main symptoms are watery diarrhoea with tummy (abdominal) cramps. The most important treatment is drinking plenty of fluids to keep hydrated. Bessoff K, Spangenberg T, Foderaro JE, Jumani RS, Ward GE, Huston CD. This site complies with the HONcode standard for trustworthy health information: verify here. Healthy dogs were medicated with a 14-day course of metronidazole; more than 50% developed diarrhea during treatment. Metronidazole is the drug of choice for acute invasive amoebic dysentery since it is very effective against vegetative forms of Entamoeba histolytica in ulcers. . The following list of medications are in some way related to or used in the treatment of this condition. Figure 7 : Cysts of Giardia lamblia,stained with iron- hematoxylin (A, B) and in a wet mount (C; from a patient seen in Haiti). An awareness of the likely aetiological agents and . If you use a breast pump during this time, throw out the milk and do not feed it to your baby. The main symptom is watery diarrhoea which occurs with stomach cramps. Its estimated that there are over 700,000 cases of cryptosporidiosis in the U.S. each year. The site is secure. Diarrhea within 24 to 48 hours of ingestion is most often caused by Campylobacter jejuni in individual cases or Salmonella in outbreaks.4 Foodborne illnesses commonly associated with fever are caused by Vibrio cholerae non-O1, Shigella, and C. jejuni (Table 4). Foodborne illnesses are becoming a greater challenge because of new and emerging microorganisms and toxins, the growth of antibiotic resistance, increasing food contamination caused by new environments and methods of food production, and an increase in multistate outbreaks.1 There are more than 250 identified pathogens that cause foodborne illness. Common metronidazole side effects may include: depression, trouble sleeping, feeling irritable; nausea, vomiting, loss of appetite, stomach pain; vaginal itching or discharge, pain during sex; This is not a complete list of side effects and others may occur. Go to the nearest ER if you cant keep any food or liquid down, have more than 10 episodes of watery diarrhea in a day or have symptoms of severe dehydration, including: Cryptosporidiosis spreads easily and can be hard to completely avoid. Has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions. Follow standard ChAMP guidelines where appropriate. Before your appointment, you may want to write a list of answers to the following questions: During the physical exam, your doctor may ask you to lie down so that he or she can gently press on various parts of your abdomen to check for tender areas. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. There is a lack of accepted safety for use under medical supervision. INTRODUCTION. Cryptosporidiosis Outbreaks United States, 20092017. It is important that you still finish the course of metronidazole that your doctor has prescribed, even if you feel better, because the infection may still be present, and it could flare up or recur if you havent finished the course. Do not drink alcohol or consume foods or medicines that contain propylene glycol while you are taking metronidazole and for at least 3 days after you stop taking it. An official website of the United States government. Ideally it is best to treat all shelter animals with a single all-purpose dewormer that is inexpensive, safe, convenient to administer, highly effective against a broad spectrum of parasites, and appropriately labeled for the intended use. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Sometimes it is not safe to use certain medicines at the same time. This list is not complete and many other drugs may interact with metronidazole. IV: Monitored (orange) antibiotic National Library of Medicine It can now be prescribed for all patients 1 year of age. Large clinical trials in humans have never been conducted to confirm this interaction. Metronidazole pregnancy and breastfeeding warnings, Detailed Metronidazole dosage information. Cryptosporidium infections are caused by microscopic parasites that are spread through drinking water or recreational water, such as swimming pools and hot tubs. Frequent public pools or reactional water areas (lakes or rivers). This is because metronidazole not only kills the bacteria responsible for conditions such as bacterial vaginosis, but useful bacteria in the vaginal flora that help to keep other microbes in check. Saving Lives, Protecting People, Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-Exposed and HIV-Infected Children, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), General Information for Immunocompromised Persons, Prevention & Control Immunocompromised Persons, Prevention & Control Childcare Facilities, Responding to Crypto Outbreaks at Childcare Facilities, Hospitals, Healthcare Facilities, & Nursing Homes, A Guide to Commercially-Bottled Water and Other Beverages, Information for Immunocompromised Persons, Information for Public Health & Medical Professionals, Water, Sanitation, & Environmentally-related Hygiene, U.S. Department of Health & Human Services. . Drink unfiltered or untreated water (often while traveling, hiking or camping). 2005 40(8):1173-80. We comply with the HONcode standard for trustworthy health information. What medications can I take for my symptoms? It causes watery diarrhea that can be severe. Parasites Giardia. Federal government websites often end in .gov or .mil. nitazoxanide (if no HIV) paromomycin (decreases diarrhea) . Contact your healthcare provider if you have symptoms of cryptosporidiosis, especially if you have large amounts of watery diarrhea (several episodes per day). Physicians should avoid attributing cases of foodborne illness to specific food sources without definitive testing and reporting. People with severe immune suppression, particularly those with advanced HIV infection . Cryptosporidium now causes over half of the reported waterborne disease outbreaks associated with swimming in chlorinated public swimming pools 9. Consumer information on food safety is available from the CDC at http://www.cdc.gov/foodsafety/facts.html or from the U.S. Food and Drug Administration at http://www.fda.gov/Food/FoodborneIllnessContaminants/FoodborneIllnessesNeedToKnow/default.htm or http://www.foodsafety.gov, or by calling (888) SAFEFOOD ([888] 7233366). Do not share this medicine with another person, even if they have the same symptoms you have. sharing sensitive information, make sure youre on a federal Accessibility Before Losing a lot of fluid can lead to serious complications, including: Bile duct, gallbladder or pancreatic disease are also complications of cryptosporidiosis. Would you like email updates of new search results? Persistent symptoms may also represent re-infection or other causes of illness besides cryptosporidiosis. Parasites Cryptosporidium (also known as Crypto). Continue reading. Usually both sexual partners are treated at the same time, even if one has no symptoms. Efficacy of treatment with paromomycin, azithromycin, and nitazoxanide in a patient with disseminated cryptosporidiosis. Supportive treatment with fluids and nutritional supplementation may be necessary. Has a currently accepted medical use in treatment in the United States. What should I do if my symptoms get worse or change? Drink plenty of fluids. . TIMOTHY L. SWITAJ, MD, KELLY J. Practicing good hygiene and sanitation routinely, and incinerating all infected birds, should reduce the potential for transmission. Yes, cryptosporidiosis is contagious it can spread from person to person, although indirectly. Most foodborne illnesses are associated with vomiting or diarrhea (more than three loose stools in 24 hours). Cryptosporidiosis is diagnosed with a stool (poop) sample. Cryptosporidiosis is the second most common cause of diarrhea in children (after rotavirus). . Federal government websites often end in .gov or .mil. 16th ed. Most people who have healthy immune systems will recover without treatment. FOIA Overdose symptoms may include nausea, vomiting, numbness, tingling, or problems with balance or muscle movement. Cryptosporidium enteritis is an infection of the small intestine characterized by diarrhea, which is caused by the parasite cryptosporidium. Stool tests may also be used to monitor the effectiveness of any treatment you receive. Metronidazole (and other nitroimidazole derivatives) is effective in the treatment of invasive disease, but less effective in the treatment of luminal forms of the parasite. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. The only drug that has FDA approval for treatment of Cryptosporidium is nitazoxanide [ 2 ]. nitazoxanide. And if youve been sick, do everything you can to avoid spreading the illness whats merely inconvenient for you may cost someone else their life. Metronidazole is an antibiotic especially effective against anaerobic infections. Dont swim if you have diarrhea. official website and that any information you provide is encrypted The first group received 360 mg/kg paromomycin twice weekly in a food item for 6 wk, and the second group received the food item with no treatment. About 10% of women report a vaginal yeast infection (vaginal candidiasis) as a side effect of metronidazole treatment. However, it is not effective in severely immunocompromised patients and there is limited data in infants. In those who have weak immune systems, the focus of treatment is often on getting the immunity back. infect the microvillar border of cells lining the small intestine and other organs. Metronidazole is active against anaerobic bacteria and some protozoa (e.g. Cryptosporidium can also infect other gastrointestinal and extraintestinal sites, especially in individuals whose immune systems are suppressed. Some evidence suggests that avoiding foods with lactose (like dairy products) can shorten the amount of time diarrhea lasts. Since you can still spread cryptosporidiosis even once your symptoms are gone, ask your employer or school when you or your child can come back. Epidemiology. Nitazoxanide has been approved for treatment of diarrhea caused by Cryptosporidium in people with healthy immune systems. Has a high potential for abuse. Clin Infect Dis. Parasitologic cure rate was a key consideration in developing prevention recommendations that ask people to refrain from swimming for 2 weeks after resolution of symptoms. In June 2004, nitazoxanide was also licensed for older children and adults. Alinia, For professionals: Keep using this medicine even if your symptoms quickly improve. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. Once inside your body, the parasite passes through your digestive tract and infects your stool. 2021 Sep 6;11:713873. doi: 10.3389/fcimb.2021.713873. This is because metronidazole not only kills the bacteria responsible for conditions such as bacterial vaginosis, but useful bacteria in the vaginal flora that help to keep other microbes in check. 2018 Mar 27;62(4):e01505-17. Expanded Access is a potential pathway for a patient with a serious or immediately life-threatening disease or condition to gain access to an investigational medical product (drug, biologic, or medical device) for treatment outside of clinical trials when no comparable or satisfactory alternative therapy options are available. Protozoal Intestinal Infections and Trichomoniasis. If your sexual partners are also being treated, then abstain from sexual intercourse until they have finished treatment. Fever, vomiting and loss of appetite occur less commonly. The reaction has been referred to as a disulfiram-like reaction disulfiram is a medication given to people to discourage alcohol consumption. This content is owned by the AAFP. Fenbendazole and metronidazole are effective against Giardia. Teach children good hand washing hygiene at a young age. You usually get it from contaminated water in public pools or other recreational swimming areas. For accuracy, you may be asked to submit several stool samples collected over a period of days. It does seems that the concern attached to this reaction is overstated. Acetate is easily oxidized by our body into carbon dioxide (CO2), which we then breathe out. and transmitted securely. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Metronidazole treatment caused a significant decrease in OPG count from 6th day post treatment and onward (P less than 0.05). Work with animals, particularly farm animals or livestock. Cleveland Clinic is a non-profit academic medical center. Centers for Disease Control and Prevention. If youve been around farm animals or at a petting zoo, wash your hands thoroughly before touching your face or eating. Cryptosporidiosis is spread through the fecal-oral route, which means you get it from accidentally swallowing poop (feces) that has parasites in it. Metronidazole will not treat a vaginal yeast infection. Cryptosporidium enteritis is an infection of the small intestine characterized by diarrhea, which is caused by the parasite cryptosporidium. . Treatment of cryptosporidiosis caused by Cryptosporidium parvum in patients with HIV infection; used alone or in conjunction with azithromycin. Cleveland Clinic is a non-profit academic medical center. Diarrhea within 24 hours of ingestion is most likely caused by C. perfringens or B. cereus. Dogs get infected with Cryptosporidium canis, while cats get C. felis and humans get C. parvum and C.hominis . Pronunciation: me-troe-NI-da-zole 2.4 Cryptosporidium spp. Empiric antibiotics should be considered in cases of suspected foodborne illness only if the patient is febrile and has signs of invasive disease (e.g., gross hematochezia, leukocytes on fecal smear), if symptoms have persisted for more than one week or are severe (i.e., more than eight liquid stools per day), or if hospitalization may be required.10,16,17,19 A fluoroquinolone (or trimethoprim/sulfamethoxazole in children) is generally recommended for empiric antibiotic therapy.5 Stool testing should still be performed. Currently, nitazoxanide is the only proven anti-parasitic treatment for Cryptosporidium infections. Weller PF. If your symptoms are mild, your doctor may recommend delaying treatment until after the first trimester or longer. Metronidazole is also used to treat infections of the gallbladder and bile . Discussion. Seven-day courses have also been used in early studies for cryptosporidiosis and other parasitic infections 6, 7. . Acetaldehyde is responsible for the unwanted effects of alcohol such as nausea, vomiting, and flushing, and is toxic. Make sure you tell your provider if you have a heart or liver condition before taking this medicine. . This will help reduce the risk of reinfection. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Empiric antibiotic therapy decreases the duration of symptoms in patients with traveler's diarrhea.5,9 Enterotoxigenic E. coli is the most common cause of traveler's diarrhea worldwide and is generally susceptible to ciprofloxacin, but azithromycin (Zithromax) is equally effective and a better choice in areas where fluoroquinolone-resistant C. jejuni is present.9,21 Patients with diarrhea of more than 10 days' duration that is associated with fatty or foul-smelling stools, cramps, bloating, and weight loss can be treated empirically for Giardia infection.22 Because of an increased risk of hemolytic uremic syndrome, patients receiving empiric antibiotic therapy should be monitored closely if Shiga toxinproducing E. coli infection is suspected.4,23, If empiric treatment has not been initiated, antibiotic therapy may be indicated once stool culture, bacterial toxin, or microscopy results are available. But it may take a couple of days before you start to feel better or notice an improvement in your symptoms. Tell your doctor if you become pregnant. Abuse may lead to moderate or low physical dependence or high psychological dependence. Ranasinghe S, Zahedi A, Armson A, Lymbery AJ, Ash A. Pathogens. In addition, it has anti-inflammatory properties in the large intestine and is an effective anti-diarrhea medication. Metronidazole does not treat chlamydia and is not a recommended treatment for chlamydia, but it may be given if symptoms of chlamydia persist after finishing a course of first-line treatments for chlamydia such as doxycycline, azithromycin, or levofloxacin. See permissionsforcopyrightquestions and/or permission requests. Incidence of Cryptosporidium spp. Foodborne illnesses should be reported to local and state health agencies; reporting requirements vary among states. We comply with the HONcode standard for trustworthy health information. It was thought that metronidazole blocked the enzyme aldehyde dehydrogenase as well, although this now seems to be incorrect. Nitazoxanide, paromomycin, and azithromycin . Symptoms of cryptosporidiosis start two to 10 days after youre exposed to Cryptosporidium. These infections can cause intestinal distress, including diarrhea. Data Sources: A PubMed search was completed using the key terms foodborne illness, infectious diarrhea, food poisoning, salmonella, Shigella, Escherichia coli, Campylobacter, food safety, hemolyticuremic syndrome, oral rehydration solution, oral rehydration therapy, traveler's diarrhea, and bloody diarrhea. Fenbendazole (50 mg/kg bodyweight orally once daily for 3-5 A large proportion of disease is caused by Giardia lamblia, Cryptosporidium parvum and Entamoeba histolytica. As Cryptosporidium and Giardia (oo)cysts are robust and resistant to environmental conditions, including disinfectants such as chlorine used in water treatment systems, numerous waterborne and foodborne outbreaks of human cryptosporidiosis and giardiasis have been reported, with Cryptosporidium and Giardia responsible for > 95% of outbreaks . You should stop using this medicine immediately if you experience any neurological symptoms such as seizures, headaches, visual changes, weakness, numbness, or tingling. An official website of the United States government. Acid fast stain - for Giardia & Cryptosporidium; Treatment of intestinal parasites. Cryptosporidium parasites, which live in the intestines of humans or animals, are shed in stool. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Many people who do have problems often get better on their own in a few weeks. Metronidazole is not approved to treat vaginal infections in girls who have not begun having menstrual periods. The https:// ensures that you are connecting to the Cryptosporidium (cryptosporidiosis) . 2022 Nov 28;16(11):e0010947. Get emergency medical help if you have signs of an allergic reaction to metronidazole (hives, itching, warmth or tingling; fever, joint pain; dry mouth, dry vagina; stuffy nose, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling). Metronidazole is effective against Bacteroides fragilis, for example, which is a normal bacterial member of the gut and mouth microbiomes but can also be a culprit in wound infection, abscesses, chest infection (often associated with pneumonia), and liver infection. However, even if symptoms disappear, cryptosporidiosis is often not curable and the symptoms may return if the immune status worsens. Cryptosporidium (crip-toe-spor-ID-ee-um) is a protozoan, a single-celled, microscopic pathogenic (disease causing) parasite that lives in the intestines of animals and people. Treatment with metronidazole (or tinidazole) is followed by a 10-day course of diloxanide furoate. If testing is performed, stool culture can provide a definitive diagnosis of infectious diarrhea and is useful for outbreak identification. The schedule may depend on the exact dosage form or strength of the medication. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Metronidazole is an antibiotic that is used to treat bacterial infections of the vagina, stomach, liver, skin, joints, brain and spinal cord, lungs, heart, or bloodstream. Giardiasis: Epidemiology, clinical manifestations, and diagnosis. An Emergency Use Authorization (EUA) allows the FDA to authorize unapproved medical products or unapproved uses of approved medical products to be used in a declared public health emergency when there are no adequate, approved, and available alternatives. Cryptosporidiosis: From Prevention to Treatment, a Narrative Review. Multiple studies support the use of a single dose of ondansetron (Zofran) in children with gastroenteritis-related vomiting.1214 The use of antiemetics in adults with gastroenteritis is reasonable, but data about adverse effects are lacking. Editorial Note: Cryptosporidium is a protozoan parasite; it is a well recognized . you took disulfiram (Antabuse) within the past 14 days. Clipboard, Search History, and several other advanced features are temporarily unavailable. Shake the oral suspension (liquid). Please enable it to take advantage of the complete set of features! Children with severe dehydration should be hospitalized and given intravenous fluids.6,7 When oral rehydration therapy or intravenous fluid administration is used in infants, care should be taken to minimize interruptions in breastfeeding or formula feeding.6,7. AHFS DI Monograph, Prescribing Information, Drug class: Currently, nitazoxanide is the only proven anti-parasitic treatment for Cryptosporidium infections. However, given the ease of travel with comorbid conditions such as human immunodeficiency virus, there is an expanding list of organisms that can cause persistent diarrhoea. How can I avoid spreading cryptosporidiosis? It may be reasonable to obtain blood cultures in patients with fever and diarrhea (with or without blood), because up to 1% of cases of nontyphoidal Salmonella infections are associated with bacteremia.4,5 Sigmoidoscopy or colonoscopy may be useful in hospitalized patients with bloody diarrhea to obtain tissue and histology, which could aid in the diagnosis. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Ask your doctor about your risk. Giacometti A, Burzacchini F, Cirioni O, Barchiesi F, Dini M, Scalise G. Eur J Clin Microbiol Infect Dis. Metronidazole is usually given for up to 10 days in a row. Disulfiram blocks the effects of this enzyme which leads to acetaldehyde accumulation causing symptoms such as skin redness, palpitations, nausea, vomiting, headache and in severe cases a dangerous rapid heart rate or a sudden drop in blood pressure. Iodoquinol or Metronidazole. This content does not have an English version. Dont drink untreated water or unpasteurized milk. Has a currently accepted medical use in treatment in the United States. Ask your provider what foods you should eat and which to avoid. Metronidazole (Flagyl . You get cryptosporidiosis from contaminated water, like pools or lakes, or from other people. Parasitologic cure (no Cryptosporidium detected in stool) rates range from 60-75% 1. FOIA Avoid getting water in your mouth if you swim in lakes, rivers or public pools. Mensah GT, Ayeh-Kumi PF, Annang AK, Owusu-Frimpong I, Niampoma S, Brown CA. a light-headed feeling (like you might pass out); blisters or ulcers in your mouth, red or swollen gums, trouble swallowing. Treatment is aiming for cessation of clinical signs and not for complete elimination of the agent. [ 2 ] Most of the time the type of Crypto infection is very specific to the type of animal. 2022 Nov 3:1-11. doi: 10.1007/s11259-022-10025-6. Gharpure R, Perez A, Miller AD, Wikswo ME, Silver R, Hlavsa MC. Has a low potential for abuse relative to those in schedule 4. HIV-positive individuals who suspect they have cryptosporidiosis should contact their healthcare provider. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Eat small bites of food if youre able to. Its important to take precautions to avoid infection with Cryptosporidium if youre: Pregnant people and infants are at higher risk of dehydration from diarrhea. Moreover, Metronidazole was found more effective than paromomycin in naturally infected lambs and kids (Shafiq et al ., 2015). Until a few decades ago, Giardia lamblia was considered an innocent bystander in the microbial gut flora, but after the pathogenicity of the parasite was recognized, different classes of drugs have been used .Current therapies, with different availability across countries, include nitroimidazole derivatives (metronidazole, tinidazole, secnidazole and ornidazole .
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