Fascioliasis Medication

  • Author: Robert W Tolan Jr, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Apr 10, 2012
 

Medication Summary

New fasciolicides are being used in small numbers of children with encouraging results and minimal toxicities. The best studied agent, bithionol, is available from the CDC Drug Service (see CDC Drug Service: Bithionol). Despite limited data on their use and safety in US children, these new fasciolicides are the DOC because of the poorer efficacy and greater toxicities of older, more familiar agents. The Medical Letter (2000 Edition) and many experts recommend triclabendazole, a veterinary drug not approved for human use in the United States, as the DOC.[19]

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Anthelmintics

Class Summary

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

  • Inhibition of microtubules causes 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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Bithionol (Lorothidol, Bitin)

 

Inhibits oxidative phosphorylation in the parasite, leading to blockade of ATP synthesis. DOC because of its safety and effectiveness for Fh and Fg. Most supporting data are from developing countries. It is a phenolic compound structurally related to hexachlorophene. Available from the CDC.

Triclabendazole (Fasinex)

 

Recent reports suggest this veterinary drug is safe, well tolerated, and effective in adults and children. It remains the second DOC until further data accumulate, supporting its preferential use. Binds selectively to fluke tubulin, disrupting microtubule formation and function. As of 2009, is unavailable in the United States.

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Praziquantel (Biltricide)

 

Although generally safe and effective for other trematode infections, praziquantel appears much less efficacious against Fh and Fg. Because it is readily available and more familiar than triclabendazole (Fasinex), it is the third DOC. Reserve use for situations in which the first and second DOC are unobtainable. Praziquantel increases permeability of the trematode tegument to calcium, causing contraction of the parasite muscle.

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Corticosteroids

Class Summary

Corticosteroids may ameliorate the treatment course in children with severe acute phase infection.

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Prednisolone (Pediapred, Delta-Cortef, Econopred)

 

A short course that is given for 2 d preceding fasciolicidal therapy in children with severe acute phase infection is reported anecdotally to ameliorate the course of the illness and to decrease fever, pain, pruritus, and toxicity.

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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: Novartis Honoraria Speaking and teaching

Specialty Editor Board

Glenn Fennelly, MD, MPH  Director, Division of Infectious Diseases, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Clinical Associate Professor of Pediatrics, Albert Einstein College of Medicine

Glenn Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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.

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

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: Nothing to disclose.

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Life cycle of Fasciola hepatica.
 
 
 
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