Pediatric Hookworm Infection Medication

  • Author: Christopher M Watson, MD, MPH; Chief Editor: Russell W Steele, MD   more...
 
Updated: Apr 26, 2012
 

Medication Summary

In the past, treatment of pregnant or lactating women was discouraged because of concerns about potential teratogenicity. These populations are now recognized as being at high risk in endemic regions, and treatment may be warranted after careful clinical consideration of the risks and benefits. Treatment may be indicated because of the high neonatal and maternal morbidity and mortality rates.

Published reports about the use of albendazole or mebendazole in children younger than 6 years are limited. In 2007, two randomized clinical trials were conducted in Vietnam among schoolchildren, aged 6-11 years.[18] The initial study compared the efficacy of single-dose mebendazole to placebo. In this study, single-dose mebendazole was found to not significantly reduce the disease burden as determined by fecal sample egg counts. In the follow-up randomized clinical trial of children aged 16 years and older, triple-dose mebendazole, triple-dose albendazole, and single-dose albendazole were compared to placebo. The findings in this study revealed greater efficacy of triple-dose albendazole in these children; the cure rate for triple-dose albendazole was 79%, compared with cure rates of 26% for triple-dose mebendazole, 45% for single-dose albendazole, and 35% for placebo.

Limited studies such as these reiterate that drug pharmacokinetics and pharmacodynamics may be altered in pediatric populations and warrant additional studies. Additionally, confounding factors such as sample size, geographic variation, and diagnostic protocols often make direct study comparison difficult. In 2007, a joint World Bank/World Health Organization conference was held to address the topic of drug efficacy and monitoring in the treatment of soil-transmitted helminth infections, with the objective of standardizing large-scale treatment programs. In response, one 2010 study demonstrated that a standardized single-dose albendazole protocol in 7 countries was able to cure most Ascaris lumbricoides (98.2%) and hookworm (87.8%) infections, but only 46.6% of Trichuris trichiura.[19] Additional studies, however, still suggest geographic hookworm sensitivity variation.[20]

The US Food and Drug Administration (FDA) has approved mebendazole for the treatment of hookworm in children older than 2 years. Albendazole is used off-label for hookworm treatment and is not advised for use in children younger than 6 years. Given this information, the following section represents treatment recommendations. The potential benefits and risks must be considered before treatment is pursued.

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Anthelmintics

Class Summary

Parasitic biochemical pathways differ from those in the human host. Therefore, toxicity is directed to the parasite, egg, or larvae. Mechanisms of action vary in the drug class. Antiparasitic actions may include the following:

  • Inhibition of microtubules, which irreversibly blocks glucose uptake
  • Inhibition of tubulin polymerization
  • Depolarizing neuromuscular blockade
  • Inhibition of cholinesterase
  • Increased permeability of the cell membrane resulting in intracellular calcium loss
  • Vacuolization of the schistosome tegument
  • Increased permeability of the cell membrane to chloride ions due to alteration of chloride channels
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Albendazole (Albenza)

 

Benzimidazole carbamate that inhibits tubulin polymerization, resulting in degeneration of cytoplasmic microtubules. Decreases production of adenosine triphosphate (ATP) in the worm, causing its energy depletion, immobilization, and finally death. Converted in liver to its primary metabolite, albendazole sulfoxide. Less than 1% of primary metabolite excreted in urine. Plasma level substantially rises (as much as 5-fold) when ingested after high-fat meal.

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Mebendazole (Vermox)

 

Recommended for treatment of eosinophilic enteritis; inhibits microtubule polymerization by binding to cytoplasmic b-tubulin; by affecting intestinal cells of parasite, prevents its use of nutrients and essentially starves it to death; dose below selectively toxic to parasites because binds to parasite b-tubulin at concentrations lower than those needed to bind mammalian protein; because acts locally on worms in GI tract, systemic drug concentration does not dictate action.

Repeat stool examination with a concentration technique recommended after 2 wk. Retreatment indicated if results positive. No fasting or purging required. Tab may be chewed, swallowed, or crushed and mixed with food.

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Pyrantel pamoate (Antiminth, Pin-Rid, Pin-X)

 

FDA approved but considered investigational for this condition. Depolarizing neuromuscular blocking agent that inhibits cholinesterases, resulting in spastic paralysis of worm.

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Contributor Information and Disclosures
Author

Christopher M Watson, MD, MPH  Assistant Professor of Pediatrics, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Assistant Professor of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine

Christopher M Watson, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Medical Association, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Patrick W Hickey, MD, FAAP  Assistant Professor of Pediatrics and Preventive Medicine, Uniformed Services University of the Health Sciences; Consulting Staff, Department of Pediatrics, Division of Pediatric Infectious Disease, Walter Reed Army Medical Center

Patrick W Hickey, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society of Tropical Medicine and Hygiene, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Ashir Kumar, MD, MBBS, FAAP  Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS, FAAP is a member of the following medical societies: American Association of Physicians of Indian Origin and Infectious Diseases Society of America

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.

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

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.

Additional Contributors

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Walter Reed National Military Medical Center, Uniformed Services University of Health Sciences, Department of the Navy, Department of the Army, or the Department of Defense.

References

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Life cycle of the hookworm. Courtesy of the Division of Parasitic Diseases, Centers for Disease Control and Prevention (CDC).
Hookworm egg. Courtesy of Patrick W Hickey, MD.
Hookworm rhabditiform larva. Courtesy of the Division of Parasitic Diseases, Centers for Disease Control and Prevention (CDC).
Hookworm filariform larva. Courtesy of the Division of Parasitic Diseases, Centers for Disease Control and Prevention (CDC).
Adult Ancylostoma duodenale worm. Anterior end with mouth parts visible. Courtesy of Patrick W Hickey, MD.
Adult Necator americanus worm. Anterior end with mouth parts visible. Courtesy of Patrick W Hickey, MD.
 
 
 
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