eMedicine Specialties > Infectious Diseases > Gastrointestinal Tract and Intra-abdominal Infections

Strongyloidiasis: Treatment & Medication

Author: Pranatharthi Haran Chandrasekar, MD, Director of Infectious Disease Fellowship, Professor, Department of Internal Medicine, Harper Hospital, Wayne State University School of Medicine
Coauthor(s): Ramesh A Bharadwaj, MD, Fellow in Infectious Diseases, Detroit Medical Center, Wayne State University; Hari Polenakovik, MD, Assistant Professor of Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH; Sylvia Polenakovik, MD, Clinical Instructor, Internist, Department of Internal Medicine, Wayne Hospital, Wright State University
Contributor Information and Disclosures

Updated: Apr 3, 2009

Treatment

Medical Care

  • Administer anthelmintic therapy.
  • Provide supportive treatment as indicated (eg, intravenous fluids if volume depletion, blood transfusion if gastrointestinal or alveolar hemorrhage, mechanical ventilation if respiratory failure).
  • Provide antibiotic therapy directed toward enteric pathogens if bacteremia or meningitis is present or suggested.
  • Reduce immunosuppression, if possible.

Surgical Care

Perform surgery in patients with acute abdominal symptoms (peritonitis due to bowel perforation or infarction) in the context of severe strongyloidiasis.

Consultations

Notify the microbiology laboratory when strongyloidiasis is suspected to ensure that specific tests are performed for optimal larval detection in stool specimens. Other consultations include the following:

  • Infectious disease specialist
  • Pulmonologist or critical care specialist
  • General surgeon

Diet

No specific diet is required in patients with strongyloidiasis.

Activity

Limit activity as tolerated by the patient.

Medication

The goal of therapy in strongyloidiasis is eradication of the parasite by using anthelmintic drugs.

Anthelmintics

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.


Ivermectin (Stromectol, Mectizan)

DOC for acute and chronic strongyloidiasis, hyperinfection syndrome, and disseminated strongyloidiasis. Binds selectively to glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing cell death. Half-life is 16 h; metabolized in liver.

Adult

200 mcg/kg/d PO for 2 d; may repeat course in 14 d

Pediatric

Administer as in adults

Documented hypersensitivity; do not use in first trimester of pregnancy and avoid use until after delivery if possible

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

Treat mothers who intend to breast feed only when risk of delayed treatment outweighs possible risks to newborn caused by ivermectin excretion in milk; repeat courses may be required in immunocompromised patients; may cause nausea, vomiting, mild CNS depression, and drowsiness


Albendazole (Albenza, Eskazole, Valbazen, Zentel)

Alternative to ivermectin for treatment of acute and chronic strongyloidiasis. Decreases ATP production in worm, causing energy depletion, immobilization, then death. To avoid inflammatory response in CNS, administer with anticonvulsants and high-dose glucocorticoids.

Adult

400 mg/d PO for 3 d; may repeat course in 14-21 d

Pediatric

<2 years: 200 mg/d PO for 3 d
>2 years: Administer as in adults

Coadministration with carbamazepine may decrease efficacy; dexamethasone, cimetidine, and praziquantel may increase toxicity

Documented hypersensitivity; do not use in first trimester of pregnancy and avoid use until after delivery if possible

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 LFTs increase significantly (resume when levels decrease to pretest values); caution in women who are breastfeeding


Thiabendazole (Mintezol)

Alternative to ivermectin for acute and chronic strongyloidiasis, hyperinfection syndrome, and disseminated infection. For mixed helminthic infections; inhibits helminth-specific mitochondrial fumarate reductase.

Adult

Acute or chronic strongyloidiasis: 1.5 g PO bid for 2 d
Hyperinfection syndrome or disseminated infection: 1.5 g PO bid for 7-14 d

Pediatric

Acute or chronic strongyloidiasis: 25 mg/kg PO bid for 2 d; not to exceed 3 g/d
Hyperinfection syndrome or disseminated infection: 25 mg/kg PO bid for 7-14 d; not to exceed 3 g/d

May elevate theophylline serum levels, increasing toxicity (monitor serum levels and reduce dose prn)

Documented hypersensitivity; do not use in the first trimester of pregnancy and avoid use until after delivery if possible

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

Closely monitor in hepatic or renal dysfunction; prior to initiating therapy, supportive therapy is necessary for anemia, dehydration, or malnutrition; use in confirmed worm infestation (not prophylactically); may cause nausea, vomiting, and mild CNS depression

More on Strongyloidiasis

Overview: Strongyloidiasis
Differential Diagnoses & Workup: Strongyloidiasis
Treatment & Medication: Strongyloidiasis
Follow-up: Strongyloidiasis
Multimedia: Strongyloidiasis
References
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Further Reading

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Keywords

strongyloidiasis, hyperinfection syndrome, disseminated strongyloidiasis, Strongyloides, threadworm infection, Cochin China diarrhea, parasitic nematodes, Strongyloides stercoralis, S stercoralis, Strongyloides fuelleborni, S fuelleborni, bacterial meningitis, rhabditiform larvae, parthenogenesis, filariform, bacteremia, Escherichia coli, E coli, Klebsiella species, helminth, strongyloidosis, acute strongyloidiasis, chronic strongyloidiasis, intestinal strongyloidiasis

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Contributor Information and Disclosures

Author

Pranatharthi Haran Chandrasekar, MD, Director of Infectious Disease Fellowship, Professor, Department of Internal Medicine, Harper Hospital, Wayne State University School of Medicine
Pranatharthi Haran Chandrasekar, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Ramesh A Bharadwaj, MD, Fellow in Infectious Diseases, Detroit Medical Center, Wayne State University
Ramesh A Bharadwaj, MD is a member of the following medical societies: American College of Physicians and Michigan State Medical Society
Disclosure: Nothing to disclose.

Hari Polenakovik, MD, Assistant Professor of Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH
Hari Polenakovik, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Sylvia Polenakovik, MD, Clinical Instructor, Internist, Department of Internal Medicine, Wayne Hospital, Wright State University
Sylvia Polenakovik, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Wesley W Emmons, MD, FACP, Assistant Professor, Department of Medicine, Thomas Jefferson University; Consulting Staff, Infectious Diseases Section, Department of Internal Medicine, Christiana Care, Newark, DE
Wesley W Emmons, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International AIDS Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, 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; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist  Speaking and teaching

CME Editor

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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