eMedicine Specialties > Pediatrics: General Medicine > Parasitology
Dracunculiasis: Treatment & Medication
Updated: Aug 22, 2006
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
- The most common practice to treat dracunculiasis still involves wrapping the worm around a stick.
- The adult worm is extracted from the patient using a stick at the skin surface and wrapping or winding the worm a few centimeters per day.
- This slow process can take many days and, in some cases, up to a few weeks, but it is required to avoid breakage and leaving behind a portion of the worm.
- Metronidazole or thiabendazole (in adults) is usually adjunctive to stick therapy and somewhat facilitates the extraction process. However, one study found that antihelminthic therapy was associated with aberrant migration of worms, resulting in infection in areas other than the lower extremity. Therefore, such medications should be used with caution.
Surgical Care
The worm also can be excised surgically where such facilities are available.
Consultations
Suspicion of dracunculiasis based on history or examination findings warrants consultation of an infectious disease specialist for involvement in management and follow-up care. This also allows for initiation of epidemiologic protocol if the patient presents in a nonendemic country.
Diet
No particular dietary changes are required during the extraction process, regardless of the time involved.
Activity
Activity is usually self-restricted because of discomfort. Recommendations are tailored for the individual, with no particular general guidelines.
Medication
Antiparasitic agents
These agents are used to speed the pace of worm extraction.
Metronidazole (Flagyl, Protostat)
DOC as therapy adjunctive to extraction. Active against various anaerobic bacteria and protozoa. Intermediate-metabolized compounds formed bind DNA and inhibit protein synthesis, causing cell death.
Adult
250 mg PO tid for 10 d
Pediatric
25 mg/kg/d PO divided tid for 10 d; not to exceed 750 mg/d
Cimetidine may increase toxicity of metronidazole; may increase effects of anticoagulants; may increase toxicity of lithium and phenytoin; disulfiramlike reaction may occur with orally ingested ethanol
Documented hypersensitivity; first trimester of pregnancy
Pregnancy
B - Usually safe but benefits must outweigh the risks.
Precautions
Do not use during first trimester of pregnancy; use caution with history of hepatic disease or concurrent hepatotoxic drugs; use cautiously with coagulopathies, history of retinal or visual changes, or CNS dysfunction
Thiabendazole (Mintezol)
Acceptable for use in adults only.
Inhibits helminth-specific mitochondrial fumarate reductase; alleviates symptoms of trichinosis during invasive phase.
Adult
50-75 mg/kg/d PO divided bid for 3 d; not to exceed 3 g/d
Pediatric
Not recommended
May elevate serum levels of theophylline, increasing toxicity (monitor serum levels and reduce dose prn)
Documented hypersensitivity
Pregnancy
C - Safety for use during pregnancy has not been established.
Precautions
Closely monitor in hepatic or renal dysfunction; before initiating therapy, supportive therapy is necessary for anemic, dehydrated, or malnourished patients; use in confirmed worm infestation (not prophylactically); may cause nausea, vomiting, and mild CNS depression
More on Dracunculiasis |
| Overview: Dracunculiasis |
| Differential Diagnoses & Workup: Dracunculiasis |
 Treatment & Medication: Dracunculiasis |
| Follow-up: Dracunculiasis |
| References |
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References
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Further Reading
Keywords
dracunculiasis, dracontiasis, dracunculosis, guinea worm infection, Dracunculus medinensis, D medinensis, guinea fire worm, Medina worm, serpent worm, dragon worm
