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.[1]
Uncomplicated strongyloidiasis
- Preferred regimen (1): Ivermectin 200 μg/kg/day PO q24h for 2 days.[2][3]
- 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 (1): Ivermectin 200 μg/kg/day PO q24h for 2 days.[2][3]
Complicated strongyloidiasis (Disseminated or hyper-infection syndrome)
- Preferred regimen (1): Ivermectin 200 μg/kg/d PO q24h orally for at least 7 to 10 days (until larvae are no longer detected in stool, sputum, or urine)
- Note: For hyper-infection and disseminated disease, adding albendazole (400 mg PO bid for 7 days) to ivermectin may be warranted.
- Preferred regimen (1): Ivermectin 200 μg/kg/d PO q24h orally for at least 7 to 10 days (until larvae are no longer detected in stool, sputum, or urine)
References
- ↑ Henriquez-Camacho C, Gotuzzo E, Echevarria J, White AC, Terashima A, Samalvides F, Pérez-Molina JA, Plana MN (2016). "Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection". Cochrane Database Syst Rev (1): CD007745. doi:10.1002/14651858.CD007745.pub3. PMC 4916931. PMID 26778150.
- ↑ 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).