- Author: Wayne Wolfram, MD, MPH; Chief Editor: Russell W Steele, MD more...
Mebendazole is not currently available in the United States. Pyrantel pamoate or albendazole (not currently approved for this use by the US Food and Drug Administration) are recommended alternatives. A second dose given 2 weeks after the initial dose is recommended.
Because asymptomatic infestation of other members in a household is frequent, simultaneously treating all household members may be reasonable. Families should be informed that repeat infestations are common. Reinfestation is treated with the same medications as the initial infestation.
Symptomatic relief of pruritus can be obtained by applying an antipruritic ointment or cream topically to the affected (usually perianal) region.
Anal albendazole may help with symptoms of pruritus ani. A recent letter to the editor stated a “local application of albendazole using an ear bud soaked with the residual albendazole suspension in the vial” in addition to the recommended oral dose of albendazole provided dramatic relief of pruritus ani.
Ivermectin has been shown to have decreased efficacy as a single agent, compared with albendazole. However, it may possess efficacy when given as an adjunct.
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.
Depolarizing neuromuscular blocking agent and inhibits cholinesterases, resulting in spastic paralysis of the worm. Purging not necessary. May be taken with milk or fruit juices.
Causes worm death by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where helminths dwell.
A benzimidazole carbamate drug that inhibits tubulin polymerization, resulting in degeneration of cytoplasmic microtubules. Decreases ATP production in worm, causing energy depletion, immobilization, and finally death. Converted in the liver to its primary metabolite, albendazole sulfoxide. Less than 1% of the primary metabolite is excreted in the urine. Plasma level is noted to rise significantly (as much as 5-fold) when ingested after high-fat meal. Experience with patients < 6 y is limited.
To avoid inflammatory response in CNS, patient must also be started on anticonvulsants and high-dose glucocorticoids.
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