Nematode Infections Medication

  • Author: Murat Hökelek, MD, PhD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Dec 5, 2011
 

Medication Summary

The goals of pharmacotherapy are to eradicate the infestation, to reduce morbidity, and to prevent complications.

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Anthelmintic agents

Class Summary

Parasite biochemical pathways are different from the human host; thus, toxicity is directed to the parasite, egg, or larvae. Mechanism of action varies within the drug class. Antiparasitic actions may include the following:

  • Inhibition of microtubules, causing irreversible block of glucose uptake
  • Tubulin polymerization inhibition
  • Depolarizing neuromuscular blockade
  • Cholinesterase inhibition
  • Increased cell membrane permeability, resulting in intracellular calcium loss
  • Vacuolization of the schistosome tegument
  • Increased cell membrane permeability to chloride ions via chloride channels alteration
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Albendazole (Albenza)

 

Used for hookworm, pinworm, and roundworm. Decreases ATP production in worm, causing energy depletion, immobilization, and, finally, death.

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Mebendazole (Vermox)

 

Indicated for treating E vermicularis (pinworm), T trichiura (whipworm), A lumbricoides (common roundworm), A duodenale (common hookworm), N americanus (American hookworm) in single or mixed infections. Efficacy varies as a function of such factors as preexisting diarrhea and GI transit time, degree of infection, and helminth strains. Causes worm death by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where helminths dwell.

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Ivermectin (Mectizan)

 

Member of avermectin class (broad-spectrum antiparasitic agents). Unique mode of action. Binds selectively with high affinity to glutamate-gated chloride ion channels in invertebrate nerve and muscle cells. Increases permeability of cell membrane to chloride ions. Results in hyperpolarization of nerve or muscle cell, causing parasite paralysis and death. Also affects other ligand-gated chloride channels (eg, those gated by GABA). Active against various life-cycle stages of most nematodes. Active against O volvulus tissue microfilariae but not adult form. Activity against S stercoralis limited to intestinal stages.

Piperazine (Vermizine)

 

Readily absorbed from GI tract, partially degraded in vivo, and excreted in urine. Paralyzes worm muscle; thus, worm expelled by normal intestinal peristalsis. Exhibits wide therapeutic index. Not available in the United States.

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Pyrantel pamoate (Antiminth, Pin-Rid)

 

Depolarizing neuromuscular blocking agent and cholinesterase inhibitor that results in spastic paralysis of worm. Active against E vermicularis (pinworm), A lumbricoides (roundworm), and A duodenale (hookworm).

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Diethylcarbamazine citrate (Hetrazan)

 

Effective in treating filariasis specific for W bancrofti, B malayi, and L loa. Does not contain any toxic metallic elements. Not recommended as DOC because of severe adverse effects. Recommended if therapy with mebendazole fails or unavailable.

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Contributor Information and Disclosures
Author

Murat Hökelek, MD, PhD  Technical Consultant of Parasitology Laboratory, Professor, Department of Clinical Microbiology, Ondokuz Mayis University Medical School, Turkey

Murat Hökelek, MD, PhD is a member of the following medical societies: Turkish Society for Parasitology

Disclosure: Nothing to disclose.

Coauthor(s)

Larry I Lutwick, MD  Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Arnold C Cua, MD  Physician, Department of Infectious Diseases, Renown Medical Center

Arnold C Cua, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph Richard Masci, MD  Professor of Medicine, Professor of Preventive Medicine, Mount Sinai School of Medicine; Director of Medicine, Elmhurst Hospital Center

Joseph Richard Masci, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, Association of Professors of Medicine, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald A Greenfield, MD  Professor, Department of Internal Medicine, University of Oklahoma College of Medicine

Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist Honoraria Speaking and teaching; Forest Pharmaceuticals Speaking and teaching

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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Strongyloides eggs in native examination from feces of a newborn.
Ascaris lumbricoides egg in feces (formalin-ethyl acetate sedimentation method).
A typical Trichuris trichiura egg in feces.
 
 
 
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