eMedicine Specialties > Pediatrics: General Medicine > Parasitology
Hymenolepiasis: Treatment & Medication
Updated: Jan 22, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
Supportive care is typically sufficient as an adjunct to drug therapy.
Consultations
In severe cases, consultation with an infectious diseases specialist or gastroenterologist may be appropriate.
Diet
The symptomatic child with severe infection may better tolerate a bland diet.
Medication
The 3 drugs that have been described for the treatment of hymenolepiasis are praziquantel, niclosamide, and paromomycin. Praziquantel, which is bacteriocidal in a single dose for all the stages of the parasite, is the drug of choice. It is available in the United States, well tolerated, and safe. Nitazoxanide has recently been studied as a new treatment option.2,3,4,5,6
Anthelmintics
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, which 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
Praziquantel (Biltricide)
The DOC, praziquantel is 80-100% effective in cases in which the burden of tapeworms is not great. Although it is FDA approved and available in the United States, its use is considered investigational for this indication.
Adult
25 mg/kg PO as a single dose; tab should be taken with food and swallowed whole with liquids (do not chew)
Pediatric
Administer as in adults
Hydantoins may reduce serum praziquantel concentrations, possibly leading to treatment failures
Documented hypersensitivity; spinal or ocular cysticercosis
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution with severe hepatic disease; possible dizziness and drowsiness
Niclosamide (Niclocide)
Effective, but unavailable in the United States. Inhibits mitochondrial oxidative phosphorylation and glucose uptake in parasite. Treatment course is 7 d because it does not reach the cysticercoids in the lamina propria.
Adult
2 g PO as a single dose, followed by 1 g PO qd for 6d
Tab to be chewed completely at least 2 h before a meal
Pediatric
<11 kg: Not established
11-34 kg: 1 g PO as a single dose, followed by 500 mg PO qd for 6d
>34 kg: 1.5 g PO as a single dose, followed by 1 g PO qd for 6d
Tab to be chewed completely at least 2 h before a meal
None reported
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Associated with GI distress, anorexia, drowsiness, dizziness, headache, and rash
Paromomycin (Humatin)
An alternative to praziquantel, but requires a 7-d course of therapy. Amebicidal and antibacterial aminoglycoside obtained from a strain of Streptomyces rimosus, active in intestinal amebiasis. Recommended for Diphyllobothrium latum, Taenia saginata, Taenia solium, Dipylidium caninum, and Hymenolepis nana.
Adult
45 mg/kg PO qd for 7 d
Pediatric
Administer as in adults
Nephrotoxic potential may increase with concurrent administration of other aminoglycosides, penicillins, cephalosporins, amphotericin B, and loop diuretics
Documented hypersensitivity; intestinal obstruction
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Possible GI disturbances, hematuria, rash, ototoxicity, and hypercholesterolemia
Nitazoxanide (Alinia)
Inhibits growth of Cryptosporidium parvum sporozoites and oocysts and Giardia lamblia trophozoites. Elicits antiprotozoal activity by interfering with pyruvate-ferredoxin oxidoreductase (PFOR) enzyme-dependent electron transfer reaction, which is essential to anaerobic energy metabolism. Available as a 20-mg/mL oral susp. Off-label use for H nana.
Adult
Not established
Pediatric
<1 year: Not established
1-4 years: 100 mg (5 mL) PO q12h for 3 d with food
4-11 years: 200 mg (10 mL) PO q12h for 3 d with food
>11 years: Not established
Tizoxanide (nitazoxanide metabolite) is >99.9% bound to plasma protein and may potentially increase toxicity of other highly plasma protein-bound drugs
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May cause abdominal pain, diarrhea, vomiting, or headache; administer with food; caution when coadministered with other highly plasma protein-bound drugs with narrow therapeutic indices
More on Hymenolepiasis |
| Overview: Hymenolepiasis |
| Differential Diagnoses & Workup: Hymenolepiasis |
 Treatment & Medication: Hymenolepiasis |
| Follow-up: Hymenolepiasis |
| References |
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References
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Further Reading
Keywords
hymenolepiasis, abdominal pain, anal pruritus, diarrhea, dwarf tapeworm, gastrointestinal infection, GI infection, hand-to-mouth infection, Hymenolepididae, Hymenolepis diminuta, H diminuta, Hymenolepis nana, H nana, nasal pruritus, parasite, parasitic infection, rodent tapeworm, urticaria
