Strongyloidiasis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Ivermectin, thiabendazole, and albendazole are the most effective medicines for treating strongyloidiasis infection. Ivermectin is the drug of choice, and albendazole is considered the least effective. Thiabendazole is not generally used in the U.S. due to adverse events, but it is still used in other countries. All patients with strongyloidiasis (even asymptomatic patients) require treatment. Complete obstruction with inadequate decompression, lack of response within an interval of 24-48 hrs, volvulus, intussusception, or perforation should be managed surgically.
Treatment
All strongyloidiasis infection (symptomatic and asymptomatic) should be treated with antimicrobial therapy. Due to the high rate of reinfection, it is sometimes necessary to repeat antimicrobial therapy.
Antimicrobial Regimen
- Strongyloides stercoralis[1]
- Preferred regimen (1): Ivermectin 200 mcg/kg/day PO qd for 2 days or two doses 2 weeks apart from each other[2]
- Alternative regimen (1): Albendazole 400 mg PO bid for 3-7 days
- Alternative regimen (2): 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)
- Alternative regimen (3): Levamisole 150 mg PO single dose. The pediatric dose is 2.5 mg/kg PO daily
- Alternative regimen (4): Pyrantel pamoate 11 mg/kg single dose PO, maximum 1.0 g
- Alternative regimen (5): Piperazine citrate 75 mg/kg/day for 2 days, maximum 3.5 g/day
References
- ↑ 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.
- ↑ "WGO Practice Guideline Management of Strongyloidiasis" (PDF).