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.

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)

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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)

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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.

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)

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

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)

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

Follow-up

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Author

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

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

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

Disclosure: Nothing to disclose.

Acknowledgements

Basim Asmar, MD Director, Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Michigan; Professor, Department of Pediatrics, Wayne State University School of Medicine

Basim Asmar, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Swati Garekar, MBBS Staff Physician, Department of Pediatrics, Children's Hospital of Michigan

Swati Garekar, MBBS is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Sections Pediatric Trichinosis
Overview
Presentation
- History
- Physical
- Causes
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DDx
Workup
Treatment
Medication
Follow-up
References

Pediatric Trichinosis Medication

Medication Summary

Anthelminthics