India · Giardiasis · Amoebiasis · Amoebic Liver Abscess · BV · Trichomoniasis · H. pylori · Fasigyn · Tiniba · Tini
✓ Longer half-life → shorter courses
✓ Better GI tolerance (less nausea)
✓ Better tissue penetration
✓ Single-dose options for giardia/BV
✗ More expensive than metronidazole
⚠️ Both require alcohol avoidance
| Indication | Adult dose | Paediatric dose | Duration |
|---|---|---|---|
| Giardiasis | 2g single dose | 50 mg/kg single dose (max 2g) | Single dose |
| Intestinal amoebiasis | 2g once daily | 50–60 mg/kg/day (max 2g) | 3 days |
| Amoebic liver abscess | 2g once daily | 50–60 mg/kg/day (max 2g) | 3–5 days |
| Bacterial vaginosis | 2g single dose OR 1g BD × 5 days | — | 1 day or 5 days |
| Trichomoniasis | 2g single dose (treat partner) | 50 mg/kg single dose | Single dose |
| Anaerobic infections | 2g stat then 1g/day OR 500mg BD | — | 5–6 days |
| H. pylori (triple therapy) | 500mg BD with clarithromycin + PPI | — | 7–14 days |
Tinidazole is a second-generation nitroimidazole with a significantly longer half-life (12–14 hours) than metronidazole (6–8 hours), allowing shorter treatment courses and once-daily dosing for most indications. It is the preferred nitroimidazole for giardiasis and amoebiasis in India due to high single-dose efficacy, better patient compliance with shorter courses, and superior GI tolerability. India has an extremely high burden of protozoal intestinal infections — Giardia lamblia and Entamoeba histolytica are among the commonest causes of acute and chronic diarrhoea — making tinidazole one of the most clinically important antiprotozoal drugs in routine Indian practice.
A single 2g oral dose of tinidazole achieves cure rates of 90–95% in giardiasis — equivalent to a 5–7 day course of metronidazole. This makes it dramatically more practical for both adults and children (paediatric dose: 50 mg/kg single dose, maximum 2g). Treatment of household contacts and safe water practices should accompany treatment, as reinfection is common in endemic settings. Stool microscopy for cysts 2–4 weeks post-treatment is recommended to confirm cure.
Tinidazole 2g once daily for 3–5 days is the first-line treatment for amoebic liver abscess (ALA) in India. Its excellent tissue penetration achieves high intrahepatic drug concentrations. After completing tinidazole, a luminal amoebicide (diloxanide furoate 500mg TDS × 10 days, or paromomycin) should always be given to eradicate intestinal cysts and prevent relapse. Percutaneous aspiration is indicated for abscesses at risk of rupture (>5cm, left lobe, imminent rupture), failure to improve after 72 hours of drug treatment, or for diagnosis when serology is unavailable.