Pediatric Trichinosis Medication

Updated: Aug 14, 2018
  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
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Medication

Medication Summary

Useful drugs in the management of trichinosis include anthelminthics to eradicate adult worms, corticosteroids for anti-inflammatory care, and nonsteroidal anti-inflammatory drugs or salicylates for analgesia. Salicylates are best avoided in children and teenaged patients with febrile illness due to risk of Reye syndrome.

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Anthelminthics

Class Summary

Mebendazole and albendazole effectively eliminate adult worms from the GI tract. Thiabendazole is not recommended because of higher incidence of adverse effects. Evidence of these drugs' efficacy against tissue larvae is not well established. Because most patients continue to harbor adult worms in the gut during the acute phase of infection, treat all patients with confirmed or suspected trichinosis to prevent continued production of newborn larvae. A double-blind placebo-controlled treatment trial of Trichinella myositis in adults showed that mebendazole and thiabendazole improve muscle tenderness compared with placebo. [25]

Albendazole (Albenza)

Not approved by the FDA to treat trichinosis. Inhibits microtubule polymerization by binding to cytoplasmic beta-tubulin. Prevents use of nutrients by the parasite by affecting intestinal cells of the parasite, essentially starving it to death. Selectively toxic to parasites at indicated dose because binding to parasite beta-tubulin occurs at a much lower concentration than binding to mammalian protein.

Mebendazole (Vermox)

Inhibits microtubule polymerization by binding to cytoplasmic beta-tubulin. Prevents use of nutrients by the parasite by affecting intestinal cells of the parasite, essentially starving it to death. Selectively toxic to parasites at indicated dose because binding to parasite beta-tubulin occurs at a much lower concentration than binding to mammalian protein. The tab may be chewed, swallowed, or crushed and mixed with food. No fasting or purging is required.

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Corticosteroids

Class Summary

Many clinical features and most complications in the acute stage of trichinosis are due to the host's immune response to larval antigens in the circulation or tissues. Corticosteroids, because of their potent anti-inflammatory actions, help control systemic inflammation. They should be used in all patients with severe or moderately severe disease. Systemic symptoms (eg, fever) dramatically respond to corticosteroid therapy within a few days.

Prednisone (Deltasone)

May decrease inflammation by reversing increased capillary permeability and by suppressing polymorphonuclear cell activity.

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Nonsteroidal anti-inflammatory drugs

Class Summary

These agents have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may also be present, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

Ibuprofen (Advil, Motrin)

DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

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