⚕️ Efficient Protocol for Waterborne Parasites (Thailand & Vietnam)

Only proceed to the next drug if the previous drug did not clear up condition, which means test and see rest days in between. For most people, single dose Albendazole is all that is required. Antibiotics does not remove parasites, and losing weight and digestive issues are likely a parasite if you have visited certain parts of the world.

Day Drug Dose Time(s) to take Target Notes
Day 1 Albendazole 400 mg — single dose 20:00 (evening) — take with a fatty meal Common intestinal helminths (Ascaris, hookworm, Trichuris) Baseline deworming; avoid if pregnant. Taking with food enhances absorption.
Days 2–4 Nitazoxanide 500 mg — twice daily (total 6 doses) 08:00 & 20:00 each day (with food) Giardia, Cryptosporidium, Blastocystis, some Entamoeba Preferred broad protozoal course; well tolerated. Do not combine with tinidazole simultaneously.
Days 5–6 Rest / Supportive care — Hydration throughout the day; probiotics morning & evening Recovery / assess response Light diet, bottled/boiled water, ORS if loose stools; consider S. boulardii or equivalent probiotic.
Day 7 (optional) Tinidazole (only if persistent symptoms) 2 g — single dose 08:00 (single dose, with food) Amoebiasis or tinidazole-responsive Giardia Use only if no improvement after nitazoxanide; avoid alcohol during and 72 h after dose; not for pregnancy.

⚕️ Efficient Protocol for Undercooked Meat or Fish Exposure (Thailand & Vietnam)

Day Drug Dose Time(s) Target Parasites Notes
Day 1 Albendazole 400 mg — single dose (with fatty meal) 20:00 General intestinal worms (*Taenia*, *Ascaris*, *Trichuris*) Basic deworming foundation. Enhances safety of later praziquantel dose.
Days 2–3 Praziquantel 25 mg/kg per dose, three doses per day (total 75 mg/kg/day) × 2 days 08:00, 14:00, 20:00 (with meals) Tapeworms, liver flukes, lung flukes Do not combine with alcohol. May cause dizziness or nausea. Liver support (hydration, rest).
Days 4–5 Rest / Recovery — Hydrate and monitor symptoms morning & night Liver and GI recovery Bland diet, probiotics, no alcohol, avoid heavy fats. Re-evaluate energy, digestion, and stool.
Day 7 Ivermectin (optional) 200 µg/kg single dose 08:00 (before breakfast) Strongyloides, other nematodes Take on empty stomach; avoid if unconfirmed filarial infection.

🌏 Unified Broad-Spectrum Parasite Treatment Protocol (Thailand & Vietnam)

Covers: Tapeworms, flukes, roundworms, Giardia, amoebae, Cryptosporidium, Strongyloides, Trichinella, and most protozoa.

Day Drug Dose Time(s) Targets Notes
Day 1 Albendazole 400 mg single dose (evening) 20:00 — with fatty meal Roundworms, hookworm, Taenia cyst stage Foundation dewormer. Precedes praziquantel to reduce cyst activation risk.
Days 2–3 Nitazoxanide 500 mg twice daily × 3 days 08:00 & 20:00 — with food Giardia, Cryptosporidium, amoebae, Blastocystis Gentle and effective for protozoa; may turn urine yellow-green temporarily.
Days 4–5 Praziquantel 25 mg/kg per dose × 3 doses per day (every 6 hours) 08:00 / 14:00 / 20:00 — with meals Tapeworms, flukes, schistosomes Take with meals. May cause dizziness or nausea. Hydrate well.
Day 7 Ivermectin (optional) 200 µg/kg single dose 08:00 — empty stomach Strongyloides, cutaneous nematodes Only if skin rash or soil contact likely. Avoid alcohol for 24 h before/after.

🇮🇳 India Specific

Day Drug Dose Time(s) to take Primary targets Notes / next steps
Day 1 (start) Albendazole 400 mg PO — single dose 20:00 — with a fatty meal STH: *Ascaris*, hookworm, *Trichuris*; partial coverage for tissue worms Baseline deworming to reduce worm load and aid recovery. Avoid in pregnancy.
Days 1–3 (start immediately) Nitazoxanide 500 mg PO twice daily × 3 days 08:00 & 20:00 — with food Protozoa: *Giardia*, *Cryptosporidium*, *Blastocystis*; some *Entamoeba* Good first-line for suspected metronidazole-resistant *Giardia/Entamoeba*. Monitor tolerance; urine may darken slightly.
Day 4 Rest / assess — Hydration, light diet, probiotics AM/PM Recovery & response check If symptoms improved → stop and monitor. If persistent/worse → follow refractory steps below (Day 5+).
Day 5 (refractory option) Tinidazole (or Metronidazole alternative) Tinidazole 2 g PO once — OR Metronidazole 500 mg PO TID × 7 days 08:00 (single tinidazole dose with food) — avoid alcohol 72 h Refractory *Giardia* or *Entamoeba* (amoebic colitis needs clinician confirmation) If *E. histolytica* suspected clinically, follow tinidazole/metronidazole with a luminal agent (e.g., paromomycin or diloxanide) per clinician.
Day 6–7 (optional) Ivermectin (only if indicated) 200 µg/kg PO once (may repeat next day if local guidance) 08:00 — empty stomach *Strongyloides* (suspected with eosinophilia, pruritic rash, pulmonary symptoms) Only use when clinical/epidemiologic suspicion; check for filarial co-endemic risk if relevant. Not for pregnancy.
Supportive (Days 1–14) Hydration, probiotics, nutrition Probiotic (e.g., S. boulardii 250 mg) AM & PM; ORS PRN Morning & evening Gut recovery, prevent dehydration Avoid raw/uncertain food & ice; follow up if weight loss continues.

⚕️ Efficient Protocol for SIBO IBS,

(Small intestinal bacterial overgrowth, Irritable Bowel Syndrome)

  • Rifaximin + Metronidazole taken at the same time
  • Rifaximin: 14 days, Metronidazole: 10–14 days
  • Rifaximin, 550 mg, 3× per day (every ~8 hours), 14 days. Example times: 08:00, 16:00, 24:00
  • Metronidazole, 500 mg, 2× per day (every ~12 hours), 14 days. Example times: 08:00, 20:00

If Rifaximin is not available,

  • Metronidazole + Ciprofloxacin
  • Metronidazole, 500 mg — 2× daily — 14 days
  • Ciprofloxacin, 500 mg — 2× daily — 7–10 days

12 hours apart, Ciprofloxacin on empty stomach, 1 hour later Metronidazole with food.

⚕️ Efficient Protocol for H. Pylori (Helicobacter pylori) (Vietnam)

H. pylori infection is highly prevalent across Vietnam, with national estimates ranging from 50-80% in adults and even higher in children (up to 92% in some studies). It is widespread due to factors like poor sanitation, etc.

Antibiotic resistance is already a problem in treating H. Pylori.

Day(s) Drug Dose Time(s) to take Primary targets Notes / next steps
Days 1–14 Proton Pump Inhibitor (PPI)
e.g., Esomeprazole		 40 mg PO twice daily 08:00 & 20:00 — before meals H. pylori (acid suppression enhances antibiotic activity) Foundation of all regimens; maintain for full 14 days. Avoid skipping doses. Can substitute with omeprazole, lansoprazole, or pantoprazole if needed.
Days 1–14 Bismuth subsalicylate (or subcitrate) 525 mg PO four times daily 07:00, 12:00, 18:00, 22:00 — with or after meals Synergistic anti–H. pylori effect, protects mucosa May darken stool or tongue (harmless). Avoid concurrent aspirin. Do not use in aspirin allergy or severe renal impairment.
Days 1–14 Tetracycline 500 mg PO four times daily 07:00, 12:00, 18:00, 22:00 — on empty stomach H. pylori (broad-spectrum bacteriostatic antibiotic) Do not take with dairy or antacids. Avoid in pregnancy or children <8 yrs. Excellent resistance profile in Vietnam (0%).
Days 1–14 Metronidazole 500 mg PO three to four times daily 08:00, 14:00, 20:00 (± midnight if QID) H. pylori (anaerobic coverage; synergistic with bismuth/tetracycline) Avoid alcohol during therapy and for 48 h after last dose. Mild metallic taste and nausea possible; take with food. Resistance can be overcome with bismuth combination.
Days 1–14 (supportive) Probiotic support (e.g., S. boulardii) 250 mg PO twice daily 08:00 & 20:00 — with or after meals Gut flora balance, reduces antibiotic side effects Optional but recommended to reduce diarrhea and dysbiosis during therapy. Continue up to 1 week after antibiotics finish.
Post-therapy (4+ weeks after completion) Follow-up testing Urea breath test or stool antigen — Confirm eradication Perform ≥4 weeks post-therapy, off PPI for 2 weeks prior. If positive, consider salvage therapy (rifabutin-based triple or furazolidone-based regimen per susceptibility).

  • Pylera: is a poly pill formula that simplifies pill burden for bismuth quadruple; retains high eradication rates. − You still need to supply a PPI separately. It has the essential anti-biotics and the bismuth in the one package. The PPI options must be added below...

PPI options

  • Esomeprazole 40 mg tablets (ask: brand names, how many tablets per blister)
  • Omeprazole 20 mg or 40 mg tablets (ask brand names)
  • Pantoprazole 40 mg tablets (ask availability)

Pylera-based Bismuth Quadruple Therapy (14 days) — Medications
Component Drug & Dose Frequency Duration Notes
Pylera® 3 capsules (each capsule contains bismuth subcitrate potassium 140 mg,
metronidazole 125 mg, tetracycline 125 mg) 		4 times daily after meals and at bedtime
(e.g. 07:00, 12:00, 18:00, 22:00) 		10–14 days Take after meals and at bedtime with a full glass of water.
Avoid alcohol during treatment and for 48 hours after (metronidazole).
Proton Pump Inhibitor (PPI) e.g. Omeprazole 20–40 mg, Esomeprazole 20–40 mg,
Pantoprazole 40 mg, or Lansoprazole 30 mg 		Twice daily (e.g. 08:00 & 20:00 — before meals) 10–14 days (complete full course) Acid suppression increases antibiotic activity and promotes mucosal healing.
Take consistently and avoid skipping doses.

  

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