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

The drug of choice for the treatment of uncomplicated strongyloidiasis is ivermectin with albendazole as the alternative. All patients who are at risk of disseminated strongyloidiasis should be treated.

Treatment

All strongyloidiasis infection (symptomatic and asymptomatic) should be treated with antimicrobial therapy.[2] Due to the high rate of reinfection, it is sometimes necessary to repeat antimicrobial therapy

Antimicrobial Regimen

• Strongyloides stercoralis

• Preferred regimen (1): Ivermectin 200 mcg/kg/day PO qd for 2 days or two doses 2 weeks apart from each other
• 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

Management of Intestinal obstruction

Intestinal obstruction due to strongyloidiasis should be managed conservatively by:

• Nasogastric decompression
• Fluid and electrolyte repletion
• Antihelminthic therapy once bowel motility is restored. Piperazine causes flaccid paralysis of the worms and this can help relieve the obstruction through rapid expulsion of the worms.
• Complete obstruction with inadequate decompression, lack of response within an interval of 24-48 hrs, volvulus, intussusception or perforation should be managed surgically.