eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Whipworm: Treatment & Medication

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Coauthor(s): Tina Slusher, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Critical Care, West Virginia University; Steven L Lanski, MD, Department of Pediatrics, Division of Pediatric Emergency Medicine, Assistant Professor, Emory University and Children's Healthcare of Atlanta at Egleston
Contributor Information and Disclosures

Updated: Jan 27, 2009

Treatment

Medical Care

Infections are treated with broad-spectrum anthelminthic agents. Most infections can be treated successfully with mebendazole. Retreatment is occasionally necessary if symptoms persist longer than 2 weeks after initial treatment.

Consultations

Consultations with the following specialists may be appropriate:

  • Infectious diseases specialist
  • Gastroenterologist 
  • Hematologist

Medication

Anthelmintics

Parasite biochemical pathways are different from the human host; thus, toxicity is directed to the parasite, egg, or larvae. Mebendazole is the treatment of choice for trichuriasis. Albendazole is an alternative medication that can be used.3 Both are broad-spectrum anthelminthic agents. These drugs interfere with the organism's microtubule formation. Recently, nitazoxanide has been studied as a possible treatment option.4,5,6


Mebendazole (Vermox)

The treatment of choice for whipworm infections. Causes worm death by selectively and irreversibly blocking uptake of glucose and other nutrients in adult intestine where helminths dwell.

Adult

100 mg PO bid for 3 d or 500 mg PO once

Pediatric

<2 years: Not established
>2 years: Administer as in adults

Carbamazepine and phenytoin may decrease effects of mebendazole; cimetidine may increase mebendazole levels

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Adjust dose in hepatic impairment; use caution when breastfeeding because extent of drug excretion is not known; use caution in patients <2 y because limited data exist


Albendazole (Albenza)

Decreases ATP production in worms, causing energy depletion, immobilization, and, finally, death. Considered investigational for use in treating this condition.

Adult

400 mg PO as a single dose for 1 d, 3-d treatment often required for heavy infestations; may repeat in 3 wk prn

Pediatric

<2 years: 200 mg PO qd for 3 d; repeat in 3 wk prn
>2 years: Administer as in adults

Coadministration with carbamazepine may decrease efficacy; dexamethasone, cimetidine, and praziquantel may increase toxicity; abdominal pain, nausea, vomiting, diarrhea, dizziness, vertigo, fever, increased intracranial pressure, and alopecia may occur

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Discontinue use if serum transaminases increase significantly (resume when levels decrease to pretreatment values)


Nitazoxanide (Alinia)

Inhibits growth of Cryptosporidium parvum sporozoites and oocysts and Giardia lamblia trophozoites. Elicits antiprotozoal activity by interfering with pyruvate-ferredoxin oxidoreductase (PFOR) enzyme-dependent electron transfer reaction, which is essential to anaerobic energy metabolism. Available as a 20-mg/mL oral susp. May have activity in trichuriasis.

Adult

500 mg PO bid for 3 d

Pediatric

<1 year: Not established
1-3 years: 100 mg (5 mL) PO q12h for 3 d with food
4-11 years: 200 mg (10 mL) PO q12h for 3 d with food
>11 years: Administer as in adults

Tizoxanide (nitazoxanide metabolite) is >99.9% bound to plasma protein and may potentially increase toxicity of other highly plasma protein-bound drugs

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

May cause abdominal pain, diarrhea, vomiting, or headache; administer with food; caution when coadministered with other highly plasma protein-bound drugs with narrow therapeutic indices

More on Whipworm

Overview: Whipworm
Differential Diagnoses & Workup: Whipworm
Treatment & Medication: Whipworm
Follow-up: Whipworm
References
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References

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Further Reading

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Keywords

whipworm, anemia, ascaris, Nematoda, parasite, parasite infection, parasitic disease, rectal prolapse, trichuriasis, Trichuris dysentery syndrome, Trichuris trichiura, T trichiura

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Coauthor(s)

Tina Slusher, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Critical Care, West Virginia University
Tina Slusher, MD is a member of the following medical societies: Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Steven L Lanski, MD, Department of Pediatrics, Division of Pediatric Emergency Medicine, Assistant Professor, Emory University and Children's Healthcare of Atlanta at Egleston
Steven L Lanski, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Ashir Kumar, MBBS, MD, FAAP, Professor, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University; Consulting Staff, Department of Pediatrics, EW Sparrow Hospital
Ashir Kumar, MBBS, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University
Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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