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Created page with "==Neurocysticercosis== {{PBI|Neurocysticercosis}} :* '''Neurocysticercosis treatment''' (NCC)<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to a..."
 
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{{PBI|Neurocysticercosis}}
{{PBI|Neurocysticercosis}}
:* '''Neurocysticercosis treatment''' (NCC)<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
:* '''Neurocysticercosis treatment''' (NCC)<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
::* 1. '''Larval form of Taenia solium'''  
::* 1. '''Larval form of Taenia solium'''  
:::* Preferred regimen: Treat Taenia solium intestinal tapeworms, if present, with [[Praziquantel]] 5-10 mg/kg PO for 1 dose for children & adults.  
:::* Preferred regimen: [Praziquantel]] 5-10 mg/kg PO for 1 dose for children & adults.  
::* 2. '''Parenchymal neurocysticercosis'''
::* 2. '''Parenchymal neurocysticercosis'''
:::* 2.1 '''Patients body weight of ≥60 kg'''
:::* 2.1 '''Patients body weight of ≥60 kg'''
::::* Preferred regimen: [[Albendazole]] 400 mg bid {{and}} [[Dexamethasone]] 0.1 mg/kg/day with or without anti-seizure medication all for 8-30 days  
::::* Preferred regimen: [[Albendazole]] 400 mg PO bid {{and}} [[Dexamethasone]] 0.1 mg/kg/day with or without anti-seizure medication all for 8-30 days  
 
:::* 2.2 '''Patients body weight of 60 kg'''
:::* 2.2 Patients body weight of 60 kg
::::* Preferred regimen: [[Albendazole]] 15 mg/kg/day PO bid (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg/day with or without anti-seizure medication] all for 8-30 days  
::::* Preferred regimen: [[Albendazole]] 15 mg/kg/day bid (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg/day with or without anti-seizure medication] all for 8-30 days  
::::* Alternative regimen: ([[Praziquantel]] 100 mg/kg per day PO tid for 1 day, then 50 mg/kg/day tid {{and}} [[Dexamethasone]] 0.1mg/kg per day with or without anti-seizure medication) all for 29 days.
:::: Note : “Viable” cysts by CT/MRI Meta-analysis: treatment associated with cyst resolution, decreased seizures, and decreased seizure recurrence.
::::* Note (1): [[Albendazole]] associated with 46% decrease in seizures.
 
::::* Note (2): [[Praziquantel]] less cysticidal activity.  
:::* Alternative regimen: ([[Praziquantel]] 100 mg/kg per day in 3 div. doses PO for 1 day, then 50 mg/kg/d in 3 doses and [[Dexamethasone]} {{and}}[[Dexamethasone]] 0.1mg/kg per day with or without anti-seizure medication) all for 29 days.
::::* Note (3): Steroids decrease serum levels of [[Praziquantel]]
 
::::* Note (4): NIH reports [[Methotrexate]] at ”20 mg/wk allows a reduction in steroid use.
:::: Note (1): [[Albendazole]] associated with 46% decrease in seizures.
 
:::: Note (2): [[Praziquantel]] less cysticidal activity.  
 
:::: Note (3): Steroids decrease serum levels of [[Praziquantel].
 
:::: Note (4): NIH reports [[Methotrexate]] at ”20 mg/wk allows a reduction in steroid use.
 
::* 3. '''Degenerating cysts'''
::* 3. '''Degenerating cysts'''
 
:::* 3.1 '''Patients body weight of ≥60 kg'''
:::* Preferred regimen: Patients body weight of ≥60 kg,[[Albendazole]] 400mg bid with meals or Patients body weight of 60 kg, [[Albendazole]] 15 mg/kg per day in 2 divided doses (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg per day with or without anti-seizure medication] all for 8-30 days
::::* Preferred regimen: [[Albendazole]] 400 mg PO bid {{and}} [[Dexamethasone]] 0.1 mg/kg/day with or without anti-seizure medication all for 8-30 days
 
:::* 3.2  '''Patients body weight of 60 kg'''
:::: Note (1): Treatment improves prognosis of associated seizures.  
::::* Preferred regimen: [[Albendazole]] 15 mg/kg/day PO bid (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg/day with or without anti-seizure medication] all for 8-30 days  
 
::::* Alternative regimen: ([[Praziquantel]] 100 mg/kg per day PO tid for 1 day, then 50 mg/kg/day tid a {{and}} [[Dexamethasone]] 0.1mg/kg per day with or without anti-seizure medication) all for 29 days.
:::: Note (2): For '''dead calcified cysts''', no treatment indicated
::::* Note (1): Treatment improves prognosis of associated seizures.  
::::* Note (2): For '''dead calcified cysts''', no treatment indicated
::* 4. '''Subarachnoid neurocysticercosis'''
::* 4. '''Subarachnoid neurocysticercosis'''
:::* Preferred regimen: (Patients body weight of ≥60 kg,[[Albendazole]] 400mg bid with meals or Patients body weight of 60 kg, [[Albendazole]] 15 mg/kg per day in 2 divided doses (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg per day with or without anti-seizure medication] all for 8-30 days) {{and}} shunting for hydrocephalus.
:::* 4.1 '''Patients body weight of ≥60 kg'''
:::: Note: Without shunt, 50% died within 9 years.
::::* Preferred regimen: [[Albendazole]] 400 mg PO bid {{and}} [[Dexamethasone]] 0.1 mg/kg/day with or without anti-seizure medication all for 8-30 days
:::* 4.2  '''Patients body weight of 60 kg'''
::::* Preferred regimen: [[Albendazole]] 15 mg/kg/day PO bid (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg/day with or without anti-seizure medication] all for 8-30 days  
:::* Alternative regimen: ([[Praziquantel]] 100 mg/kg per day PO tid for 1 day, then 50 mg/kg/day tid  {{and}} [[Dexamethasone]] 0.1mg/kg per day with or without anti-seizure medication) all for 29 days.
:::: Note: Shunting for hydrocephalus, as without shunt, 50% of patients died within 9 years.
::* 5. '''Intraventricular neurocysticercosis'''
::* 5. '''Intraventricular neurocysticercosis'''
:::* Preferred regimen: (Patients body weight of ≥60 kg,[[Albendazole]] 400mg bid with meals or Patients body weight of 60 kg, [[Albendazole]] 15 mg/kg per day in 2 divided doses (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg per day with or without anti-seizure medication] all for 8-30 days) {{and}} perhaps neuroendoscopic removal if obstruction of CSF circulation.
:::* 5.1 '''Patients body weight of ≥60 kg'''
::::* Preferred regimen: [[Albendazole]] 400 mg PO bid {{and}} [[Dexamethasone]] 0.1 mg/kg/day with or without anti-seizure medication all for 8-30 days
:::* 5.2  '''Patients body weight of 60 kg'''
::::* Preferred regimen: [[Albendazole]] 15 mg/kg/day PO bid (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg/day with or without anti-seizure medication] all for 8-30 days  
:::*  Alternative regimen: ([[Praziquantel]] 100 mg/kg per day PO tid for 1 day, then 50 mg/kg/day tid {{and}} [[Dexamethasone]] 0.1mg/kg per day with or without anti-seizure medication) all for 29 days
:::* Note: Neuroendoscopic removal if obstruction of CSF circulation.


==Sparganosis==
==Sparganosis==

Revision as of 18:11, 22 July 2015

Neurocysticercosis

  • Neurocysticercosis treatment (NCC)[1]
  • 1. Larval form of Taenia solium
  • Preferred regimen: [Praziquantel]] 5-10 mg/kg PO for 1 dose for children & adults.
  • 2. Parenchymal neurocysticercosis
  • 2.1 Patients body weight of ≥60 kg
  • Preferred regimen: Albendazole 400 mg PO bid AND Dexamethasone 0.1 mg/kg/day with or without anti-seizure medication all for 8-30 days
  • 2.2 Patients body weight of 60 kg
  • Preferred regimen: Albendazole 15 mg/kg/day PO bid (max. 800 mg/day) AND Dexamethasone 0.1 mg/kg/day with or without anti-seizure medication] all for 8-30 days
  • Alternative regimen: (Praziquantel 100 mg/kg per day PO tid for 1 day, then 50 mg/kg/day tid AND Dexamethasone 0.1mg/kg per day with or without anti-seizure medication) all for 29 days.
  • Note (1): Albendazole associated with 46% decrease in seizures.
  • Note (2): Praziquantel less cysticidal activity.
  • Note (3): Steroids decrease serum levels of Praziquantel
  • Note (4): NIH reports Methotrexate at ”20 mg/wk allows a reduction in steroid use.
  • 3. Degenerating cysts
  • 3.1 Patients body weight of ≥60 kg
  • Preferred regimen: Albendazole 400 mg PO bid AND Dexamethasone 0.1 mg/kg/day with or without anti-seizure medication all for 8-30 days
  • 3.2 Patients body weight of 60 kg
  • Preferred regimen: Albendazole 15 mg/kg/day PO bid (max. 800 mg/day) AND Dexamethasone 0.1 mg/kg/day with or without anti-seizure medication] all for 8-30 days
  • Alternative regimen: (Praziquantel 100 mg/kg per day PO tid for 1 day, then 50 mg/kg/day tid a AND Dexamethasone 0.1mg/kg per day with or without anti-seizure medication) all for 29 days.
  • Note (1): Treatment improves prognosis of associated seizures.
  • Note (2): For dead calcified cysts, no treatment indicated
  • 4. Subarachnoid neurocysticercosis
  • 4.1 Patients body weight of ≥60 kg
  • Preferred regimen: Albendazole 400 mg PO bid AND Dexamethasone 0.1 mg/kg/day with or without anti-seizure medication all for 8-30 days
  • 4.2 Patients body weight of 60 kg
  • Preferred regimen: Albendazole 15 mg/kg/day PO bid (max. 800 mg/day) AND Dexamethasone 0.1 mg/kg/day with or without anti-seizure medication] all for 8-30 days
  • Alternative regimen: (Praziquantel 100 mg/kg per day PO tid for 1 day, then 50 mg/kg/day tid AND Dexamethasone 0.1mg/kg per day with or without anti-seizure medication) all for 29 days.
Note: Shunting for hydrocephalus, as without shunt, 50% of patients died within 9 years.
  • 5. Intraventricular neurocysticercosis
  • 5.1 Patients body weight of ≥60 kg
  • Preferred regimen: Albendazole 400 mg PO bid AND Dexamethasone 0.1 mg/kg/day with or without anti-seizure medication all for 8-30 days
  • 5.2 Patients body weight of 60 kg
  • Preferred regimen: Albendazole 15 mg/kg/day PO bid (max. 800 mg/day) AND Dexamethasone 0.1 mg/kg/day with or without anti-seizure medication] all for 8-30 days
  • Alternative regimen: (Praziquantel 100 mg/kg per day PO tid for 1 day, then 50 mg/kg/day tid AND Dexamethasone 0.1mg/kg per day with or without anti-seizure medication) all for 29 days
  • Note: Neuroendoscopic removal if obstruction of CSF circulation.

Sparganosis

  • Sparganosis (Spirometra mansonoides) treatment [2]
  • Preferred treatment: Surgical resection or ethanol injection of subcutaneous masses
Note: Source for Spirometra mansonoides larval cysts is frogs or snakes
  1. ↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
  2. ↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
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