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The majority of cases of Löffler syndrome are self-limited and require only supportive care. Nevertheless, pharmacologic medical therapy is recommended among patients with parasitic infections and hence, appropriate use of [[Anthelmintic|anthelmintic drugs]] is warranted. Additionally, patients with sever symptoms are treated with [[Corticosteroid|corticosteroids]]. [[Anti inflammatory medications|Anti-inflammatory]] effects of [[Corticosteroid|corticosteroids]], reverse increased capillary permeability and suppress [[Neutrophil|PMN]] activity. [[Corticosteroid]]<nowiki/>s such as [[prednisone]] decrease [[Interleukin 5|interleukin-5]], and [[granulocyte macrophage colony stimulating factor]], and hence decrease eosinophil survival.
The majority of cases of Löffler syndrome are self-limited and require only supportive care. Nevertheless, pharmacologic medical therapy is recommended among patients with parasitic infections and hence, appropriate use of [[Anthelmintic|anthelmintic drugs]] is warranted. Additionally, patients with sever symptoms are treated with [[Corticosteroid|corticosteroids]]. [[Anti inflammatory medications|Anti-inflammatory]] effects of [[Corticosteroid|corticosteroids]], reverse increased capillary permeability and suppress [[Neutrophil|PMN]] activity. [[Corticosteroid]]<nowiki/>s such as [[prednisone]] decrease [[Interleukin 5|interleukin-5]], and [[granulocyte macrophage colony stimulating factor]], and hence decrease eosinophil survival.
==Medical Therapy==
==Medical Therapy==
*The majority of cases of Löffler syndrome are self-limited and require only supportive care. Nevertheless, pharmacologic medical therapy is recommended among patients with parasitic infections and hence, appropriate use of [[Anthelmintic|anthelmintic drugs]] is warranted. Additionally, patients with sever symptoms are treated with [[Corticosteroid|corticosteroids]]. [[Anti inflammatory medications|Anti-inflammatory]] effects of [[Corticosteroid|corticosteroids]], reverse increased capillary permeability and suppress [[Neutrophil|PMN]] activity. [[Corticosteroid]]<nowiki/>s such as [[prednisone]] decrease [[Interleukin 5|interleukin-5]], and [[granulocyte macrophage colony stimulating factor]], and hence decrease eosinophil survival.
*The majority of cases of Löffler syndrome are self-limited and require only supportive care.  
*Nevertheless, pharmacologic medical therapy is recommended among patients with parasitic infections and hence, appropriate use of [[Anthelmintic|anthelmintic drugs]] is warranted.  
*Additionally, patients with sever symptoms are treated with [[Corticosteroid|corticosteroids]].
*[[Anti inflammatory medications|Anti-inflammatory]] effects of [[Corticosteroid|corticosteroids]], reverse increased capillary permeability and suppress [[Neutrophil|PMN]] activity. [[Corticosteroid|Co]]<nowiki/>[[Corticosteroid|rticosteroid]]<nowiki/>s such as [[prednisone]] decrease [[Interleukin 5|interleukin-5]], and [[granulocyte macrophage colony stimulating factor|granulocyte macrophage colony stimul]]<nowiki/>[[granulocyte macrophage colony stimulating factor|ating factor]], and hence decrease eosinophil survival.
*
*
*
*
*
*
*'''Strongyloidiasis'''
*
:* Preferred regimen (1): [[Ivermectin]] 200 μg/kg/day PO q24h for 2 days.<ref name="pmid8483992">{{cite journal| author=Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR| title=Albendazole is effective treatment for chronic strongyloidiasis. | journal=Q J Med | year= 1993 | volume= 86 | issue= 3 | pages= 191-5 | pmid=8483992 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8483992  }} </ref><ref>{{Cite web | title = WGO Practice Guideline Management of Strongyloidiasis| url = http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/15_management_strongyloidiasis_en.pdf}}</ref>
*
:** Note: For [[immunocompromised]] patients, several treatment courses at 2-week intervals is recommended.
*
:* Alternative regimen (1): [[Thiabendazole]] 1.5 g PO q24h for 2 consecutive days.
*
*'''<big>Strongyloidiasis</big>'''
:* '''Preferred regimen''' '''(1):'''
:* [[Ivermectin]] 200 μg/kg/day PO q<nowiki/>24h for 2 days.<ref name="pmid8483992">{{cite journal| author=Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR| title=Albendazole is effective treatment for chronic strongyloidiasis. | journal=Q J Med | year= 1993 | volume= 86 | issue= 3 | pages= 191-5 | pmid=8483992 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8483992  }} </ref><ref>{{Cite web | title = WGO Practice Guideline Management of Strongyloidiasis| url = http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/15_management_strongyloidiasis_en.pdf}}</ref>
:** Note: For [[immunocompromised]] patients, several treatment c<nowiki/>ourses at 2-week intervals is recommended.
:* '''Alternative regimen (1):'''
:* [[Thiabendazole]] 1.5 g PO q24h for 2 consecutive days.
:** Note: The maximum dosage is 3 g/d every 2 days (this dosage is likely to be toxic and needs to be reduced)
:** Note: The maximum dosage is 3 g/d every 2 days (this dosage is likely to be toxic and needs to be reduced)
:** Note: Cure rates are as high as 87% to 94%, but the drug may not be effective in the disease that is disseminated beyond the [[gastrointestinal tract]].
:** Note: Cure rates are as high <nowiki/>as 8<nowiki/>7% t<nowiki/>o 94<nowiki/>%, but the drug may not be effective in the disease that is disseminated beyond the [[gastrointestinal tract]].
:** Note: Many patients have [[gastrointestinal]] adverse effects, it is used rarely in the U.S. because of adverse effects
:** Note: Many patients have [[gastrointestinal]] adverse effects, it is used rarely in the U.S. because of adverse effects
:* Alternative regimen (2): [[Albendazole]] 400 mg PO bid for 3 days
:* '''Alternative regimen (2):'''
:* [[Albendazole]] 400 mg PO bid for 3 days
* '''<big>Ascariasis</big>'''<ref name="Principles and Practice">Durand, Marlene (2015). "Chapter 288:Intestinal Nematodes (Roundworms)". Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition. Elsevier. pp. 3199–3207. ISBN 978-1-4557-4801-3.</ref><ref name="cdc1">Centers for Disease Control and Prevention.https://www.cdc.gov/parasites/ascariasis/health_professionals/index.html#tx Accessed on the 6th of March, 2017.</ref><ref name="pmid9580117">{{cite journal| author=Romero Cabello R, Guerrero LR, Muñóz García MR, Geyne Cruz A| title=Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico. | journal=Trans R Soc Trop Med Hyg | year= 1997 | volume= 91 | issue= 6 | pages= 701-3 | pmid=9580117 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9580117  }} </ref><ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040  }} </ref><ref name="Nelson Textbook of Pediatrics">Kliegman, Robert; Stanton, Bonita; St. Geme, Joseph; Schor, Nina (2016). "Chapter 291:Ascariasis (Ascaris lumbricoides)". Nelson Textbook of Pediatrics Twentieth Edition. Elsevier. pp. 1733–1734. ISBN 978-1-4557-7566-8.</ref>


"""Ascariasis"""<ref name="Principles and Practice">Durand, Marlene (2015). "Chapter 288:Intestinal Nematodes (Roundworms)". Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition. Elsevier. pp. 3199–3207. ISBN 978-1-4557-4801-3.</ref><ref name="cdc1">Centers for Disease Control and Prevention.https://www.cdc.gov/parasites/ascariasis/health_professionals/index.html#tx Accessed on the 6th of March, 2017.</ref><ref name="pmid9580117">{{cite journal| author=Romero Cabello R, Guerrero LR, Muñóz García MR, Geyne Cruz A| title=Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico. | journal=Trans R Soc Trop Med Hyg | year= 1997 | volume= 91 | issue= 6 | pages= 701-3 | pmid=9580117 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9580117  }} </ref><ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040  }} </ref><ref name="Nelson Textbook of Pediatrics">Kliegman, Robert; Stanton, Bonita; St. Geme, Joseph; Schor, Nina (2016). "Chapter 291:Ascariasis (Ascaris lumbricoides)". Nelson Textbook of Pediatrics Twentieth Edition. Elsevier. pp. 1733–1734. ISBN 978-1-4557-7566-8.</ref>
* '''Preferred regimen:'''
* Preferred regimen
* [[Albendazole]] 400 mg PO single dose. [[Albendazole]] dose for children between the ages of 1-2 years is 200 mg.  
# [[Albendazole]] 400 mg PO single dose. [[Albendazole]] dose for children between the ages of 1-2 years is 200 mg.
* [[Mebendazole]] 500 mg PO single dose or 100 mg bid for 3 days
# [[Mebendazole]] 500 mg PO single dose or 100 mg bid for 3 days
* Alternative regimen
# [[Ivermectin]] 150 to 200 µg/kg PO single dose
# [[Nitazoxanide]] 500 mg bid for 3 days (adolescents and adults); 200mg bid for 3 days (children 4-11 yrs of age); 100mg PO bid for 3 days (children 1-3 yrs of age)
# [[Levamisole]] 150 mg PO single dose. The pediatric dose is 2.5 mg/kg PO daily
# [[Pyrantel pamoate]] 11 mg/kg single dose PO, maximum 1.0 g
# [[Piperazine citrate]] 75 mg/kg/day for 2 days, maximum 3.5 g/day


* '''Alternative regimen'''
* [[Ivermectin]] 150 to 200 µg/kg PO single dose
* [[Nitazoxanide]] 500 mg bid for 3 days (adolescents and adults); 200mg bid for 3 days (children 4-11 yrs of age); 100mg PO bid for 3 days (children 1-3 yrs of age)
* [[Levamisole]] 150 mg PO single dose. The pediatric dose is 2.5 mg/kg PO daily
* [[Pyrantel pamoate]] 11 mg/kg single dose PO, maximum 1.0 g
* [[Piperazine citrate]] 75 mg/kg/day for 2 days, maximum 3.5 g/day








 
*
 
**
 
 
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===
*'''1 Stage 1 - Name of stage'''
**1.1 '''Specific Organ system involved 1'''
***1.1.1 '''Adult'''
****Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)'''
****Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
****Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
****Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
****Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
****Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
***1.1.2 '''Pediatric'''
****1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
*****Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
*****Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
*****Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
*****Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
*****Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
*****Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
*****Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
*****Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
*****Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
**1.2 '''Specific Organ system involved 2'''
***1.2.1 '''Adult'''
****Preferred regimen (1): [[drug name]] 500 mg PO q8h
***1.2.2  '''Pediatric'''
****Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
 
*2 '''Stage 2 - Name of stage'''
**2.1 '''Specific Organ system involved 1 '''
**:'''Note (1):'''
**:'''Note (2)''':
**:'''Note (3):'''
***2.1.1 '''Adult'''
****Parenteral regimen
*****Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
*****Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
*****Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
****Oral regimen
*****Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
*****Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
*****Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
*****Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
*****Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
*****Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
***2.1.2 '''Pediatric'''
****Parenteral regimen
*****Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
*****Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
*****Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
****Oral regimen
*****Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
*****Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
*****Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
*****Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
*****Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
*****Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
**2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**:'''Note (1):'''
**:'''Note (2)''':
**:'''Note (3):'''
***2.2.1 '''Adult'''
****Parenteral regimen
*****Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
*****Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
*****Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
****Oral regimen
*****Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
*****Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
*****Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
*****Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
*****Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
*****Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
***2.2.2 '''Pediatric'''
****Parenteral regimen
*****Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
*****Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
*****Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
****Oral regimen
*****Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
*****Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
*****Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
*****Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
*****Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
*****Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Revision as of 19:37, 6 June 2019


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

The majority of cases of Löffler syndrome are self-limited and require only supportive care. Nevertheless, pharmacologic medical therapy is recommended among patients with parasitic infections and hence, appropriate use of anthelmintic drugs is warranted. Additionally, patients with sever symptoms are treated with corticosteroids. Anti-inflammatory effects of corticosteroids, reverse increased capillary permeability and suppress PMN activity. Corticosteroids such as prednisone decrease interleukin-5, and granulocyte macrophage colony stimulating factor, and hence decrease eosinophil survival.

Medical Therapy

  • Preferred regimen (1):
  • Ivermectin 200 μg/kg/day PO q24h for 2 days.[1][2]
    • Note: For immunocompromised patients, several treatment courses at 2-week intervals is recommended.
  • Alternative regimen (1):
  • Thiabendazole 1.5 g PO q24h for 2 consecutive days.
    • Note: The maximum dosage is 3 g/d every 2 days (this dosage is likely to be toxic and needs to be reduced)
    • Note: Cure rates are as high as 87% to 94%, but the drug may not be effective in the disease that is disseminated beyond the gastrointestinal tract.
    • Note: Many patients have gastrointestinal adverse effects, it is used rarely in the U.S. because of adverse effects
  • Alternative regimen (2):
  • Albendazole 400 mg PO bid for 3 days
  • Preferred regimen:
  • Albendazole 400 mg PO single dose. Albendazole dose for children between the ages of 1-2 years is 200 mg.
  • Mebendazole 500 mg PO single dose or 100 mg bid for 3 days
  • Alternative regimen
  • Ivermectin 150 to 200 µg/kg PO single dose
  • Nitazoxanide 500 mg bid for 3 days (adolescents and adults); 200mg bid for 3 days (children 4-11 yrs of age); 100mg PO bid for 3 days (children 1-3 yrs of age)
  • Levamisole 150 mg PO single dose. The pediatric dose is 2.5 mg/kg PO daily
  • Pyrantel pamoate 11 mg/kg single dose PO, maximum 1.0 g
  • Piperazine citrate 75 mg/kg/day for 2 days, maximum 3.5 g/day



References

  1. ↑ Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR (1993). "Albendazole is effective treatment for chronic strongyloidiasis". Q J Med. 86 (3): 191–5. PMID 8483992.
  2. ↑ "WGO Practice Guideline Management of Strongyloidiasis" (PDF).
  3. ↑ Durand, Marlene (2015). "Chapter 288:Intestinal Nematodes (Roundworms)". Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition. Elsevier. pp. 3199–3207. ISBN 978-1-4557-4801-3.
  4. ↑ Centers for Disease Control and Prevention.https://www.cdc.gov/parasites/ascariasis/health_professionals/index.html#tx Accessed on the 6th of March, 2017.
  5. ↑ Romero Cabello R, Guerrero LR, Muñóz García MR, Geyne Cruz A (1997). "Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico". Trans R Soc Trop Med Hyg. 91 (6): 701–3. PMID 9580117.
  6. ↑ Khuroo MS (1996). "Ascariasis". Gastroenterol Clin North Am. 25 (3): 553–77. PMID 8863040.
  7. ↑ Kliegman, Robert; Stanton, Bonita; St. Geme, Joseph; Schor, Nina (2016). "Chapter 291:Ascariasis (Ascaris lumbricoides)". Nelson Textbook of Pediatrics Twentieth Edition. Elsevier. pp. 1733–1734. ISBN 978-1-4557-7566-8.

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