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In recent years, the number of giardiasis cases failing nitroimidazole therapy has risen — and second-line choices, often driven by pricing and availability, are not evidence-based. Before the advent of nitroimidazoles, quinacrine was widely prescribed. In an open-label trial in Europe, investigators prospectively enrolled 106 patients with giardiasis who failed nitroimidazoles and had persistently positive stool microscopy for Giardia duodenalis to receive quinacrine monotherapy (Q-MT) or albendazole with chloroquine combination therapy (AC-CT) for 5 days based on drug availability. In all, 73 patients received Q-MT and 33 received AC-CT (9 of whom crossed over to Q-MT after therapy failure). Travel to India was the risk factor for disease…