Loefflers syndrome medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

The majority of cases of Löffler syndrome are self-limited and require only supportive care. Nevertheless, pharmacologic medical therapy is recommended among patients with parasitic infections and hence, appropriate use of anthelmintic drugs is warranted. Additionally, patients with sever symptoms are treated with corticosteroids. Anti-inflammatory effects of corticosteroids, reverse increased capillary permeability and suppress PMN activity. Corticosteroids such as prednisone decrease interleukin-5, and granulocyte macrophage colony stimulating factor, and hence decrease eosinophil survival.

Medical Therapy

• The majority of cases of Löffler syndrome are self-limited and require only supportive care.
• Nevertheless, pharmacologic medical therapy is recommended among patients with parasitic infections and hence, appropriate use of anthelmintic drugs is warranted.
• Additionally, patients with sever symptoms are treated with corticosteroids.
• Anti-inflammatory effects of corticosteroids, reverse increased capillary permeability and suppress PMN activity. Corticosteroids such as prednisone decrease interleukin-5, and granulocyte macrophage colony stimulating factor, and hence decrease eosinophil survival.
• Corticosteroids therapy

• Only indicated in sever cases
• There is no guideline for corticosteroid therapy of patient with Löffler syndrome
• Decision making and dosage determination is case based with respect to the presentation of the patient.
• In sever cases, suggested starting dose is 1 mg/kg/day of prednisone or equivalent with slow tapering over 6–8 weeks

• Strongyloidiasis

• 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 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

• Ascariasis

• Preferred regimen:
• Albendazole 400 mg PO single dose. Albendazole dose for children between the ages of 1-2 years is 200 mg.
• Mebendazole 500 mg PO single dose or 100 mg bid for 3 days

• Alternative regimen
• Ivermectin 150 to 200 µg/kg PO single dose
• 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)
• Levamisole 150 mg PO single dose. The pediatric dose is 2.5 mg/kg PO daily
• Pyrantel pamoate 11 mg/kg single dose PO, maximum 1.0 g
• Piperazine citrate 75 mg/kg/day for 2 days, maximum 3.5 g/day