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.[1]
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 [2]
- Preferred regimen (1): Ivermectin 200 mcg/kg/day PO qd for 2 days or two doses 2 weeks apart from each other[3]
- 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.
References
- ↑ http://www.dpd.cdc.gov/dpdx/HTML/Strongyloidiasis.htm
- ↑ 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).