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Gnathostomiasis Medication

  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
Updated: Jun 20, 2015

Medication Summary

Although surgical removal, when possible, is the treatment of choice in gnathostomiasis, albendazole appears to have an increasing role in complementing surgical intervention.[14] Ivermectin in a single dose is better tolerated than albendazole but may be less effective.[15] Mebendazole, which was formerly used, had variable results and due to significant toxicities should no longer be used. Adjunctive corticosteroid therapy, as an anti-inflammatory, may have a role in the treatment of CNS disease.



Class Summary

These agents are the drugs of choice when surgical treatment is not possible or successful. 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 that 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

Albendazole (Albenza)


DOC for treating gnathostomiasis. A synthetic nitroimidazole that binds to tubulin, inhibits microtubule assembly, decreases glucose absorption, and inhibits fumarate reductase in the parasite. Poorly soluble in water, it is well absorbed when taken with a fatty meal. Concentration in the cerebrospinal fluid reaches 40% of that in the serum. Two treatment courses may be required.

Thiabendazole (Mintezol)


A synthetic benzimidazole that should be used only when albendazole is not available because of its toxicities and questionable efficacy. Its mechanism of action is thought to be similar to that of albendazole.

Ivermectin (Mectizan, Stromectol)


Binds selectively with glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing cell death. Half-life is 16 h; metabolized in liver.



Class Summary

These agents may have an ancillary role in reducing inflammation associated with CNS gnathostomiasis.

Dexamethasone (Decadron, Dexone)


Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Contributor Information and Disclosures

Germaine L Defendi, MD, MS, FAAP Associate Clinical Professor, Department of Pediatrics, Olive View-UCLA Medical Center

Germaine L Defendi, MD, MS, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

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.

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