Sandbox 2

Medical therapy

Uncomplicated strongylidiasis

• Strongyloides stercoralis

• Preferred regimen (1): Ivermectin 200 μg/kg/day PO q24h for 2 days
• 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 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

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.