Trichinosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac
Overview
The mainstay of therapy for trichinosis are anthelmintics drugs such as albendazole or mebendazole.[1]
Medical Therapy
Treatment for asymptomatic, abortive and mild patients:
- Administration of anthelmintics
- Administration of glucocorticoids if needed.
Treatment for pronounced and severe patients:
- Hospitalization
- Compulsory for severe cases
- Administration of glucocorticoids, anthelmintics and analgesics.
- Administration of fluids and electrolytes [2]
Antihelmintic Regimen[1]
- Trichinosis in adult and children ≥2yrs of age
- Preferred regimen (1): Albendazole 400 mg PO bid for 8 to 14 days Template:OR Mebendazole 200-400 mg PO tid for 3 days, then 400-500 mg PO tid for 10 days
- Note:
- Albendazole:
- Pregnancy: Albendazole is pregnancy category C. Data on the use of albendazole in pregnant women are limited, though the available evidence suggests no difference in congenital abnormalities in the children of women who were accidentally treated with albendazole during mass prevention campaigns compared with those who were not. In mass prevention campaigns for which the World Health Organization (WHO) has determined that the benefit of treatment outweighs the risk, WHO allows use of albendazole in the 2nd and 3rd trimesters of pregnancy. However, the risk of treatment in pregnant women who are known to have an infection needs to be balanced with the risk of disease progression in the absence of treatment.
- Lactation: It is not known whether albendazole is excreted in human milk. Albendazole should be used with caution in breastfeeding women.
- Pedriatic patients: The safety of albendazole in children less than 6 years old is not certain. Studies of the use of albendazole in children as young as one year old suggest that its use is safe. According to WHO guidelines for mass prevention campaigns, albendazole can be used in children as young as 1 year old. Many children less than 6 years old have been treated in these campaigns with albendazole, albeit at a reduced dose.
- Mebendazole:
- Pregnancy: Mebendazole is in pregnancy category C. Data on the use of mebendazole in pregnant women are limited. The available evidence suggests no difference in congenital anomalies in the children of women who were treated with mebendazole during mass treatment programs compared with those who were not. In mass treatment programs for which the World Health Organization (WHO) has determined that the benefit of treatment outweighs the risk, WHO allows use of mebendazole in the 2nd and 3rd trimesters of pregnancy. The risk of treatment in pregnant women who are known to have an infection needs to be balanced with the risk of disease progression in the absence of treatment.
- Lactation: It is not known whether mebendazole is excreted in breast milk. The WHO classifies mebendazole as compatible with breastfeeding and allows the use of mebendazole in lactating women.
- Pedriatic patients: The safety of mebendazole in children has not been established. There is limited data in children age 2 years and younger. Mebendazole is listed as an intestinal antihelminthic medicine on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.
- Albendazole:
- Trichinosis in adult and children ≥2yrs of age
- Both drugs are considered relatively safe but have been associated with side effects including bone marrow suppression.
- Patients on longer courses of therapy should be monitored by serial complete blood counts to detect any adverse effects promptly and discontinue treatment.
- Albendazole and mebendazole are not approved for use in pregnant women or children under the age of 2 years.
- In addition to antiparasitic medication, treatment with glucocorticoids such as prednisone may be used to relieve muscle pain associated with larval migration.[1]
References
- ↑ 1.0 1.1 1.2 Trichinellosis. CDC. http://www.cdc.gov/parasites/trichinellosis/health_professionals/index.html#tx. Accessed on January 26, 2016
- ↑ Gottstein B, Pozio E, Nöckler K (2009). "Epidemiology, diagnosis, treatment, and control of trichinellosis". Clin Microbiol Rev. 22 (1): 127–45, Table of Contents. doi:10.1128/CMR.00026-08. PMC 2620635. PMID 19136437.