Intestinal Flukes Treatment & Management

Updated: Jul 14, 2016
  • Author: Joseph Adrian L Buensalido, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Treatment

Medical Care

Praziquantel 10-20 mg/kg as a single dose or 25 mg/kg 3 times a day is the recommended treatment for intestinal flukes (including F buski infection). It should be taken with liquids during a meal. [4] Praziquantel is the drug of choice for most intestinal fluke infections, although niclosamide has been reported to have some in vitro efficacy. [44]

Praziquantel is a pyrazinoisoquinoline anthelmintic that was discovered in 1972 by Bayer Germany. Although widely used, praziquantel exhibits low and erratic bioavailability because of its poor water solubility. Nanostructured lipid carriers (NLC), second-generation solid lipid nanoparticles, were developed in the 1990s to improve the bioavailability of poorly water-soluble drugs. [45]

After 4 weeks, if the repeat stool examination result is again positive, retreatment with praziquantel is indicated. [33]

The recommended treatment options for fascioliasis (liver fluke infection with F hepatica or F gigantica), include triclabendazole 10 mg/kg as a single dose (and may be repeated after 12-24 hours in heavy infections) or bithionol 30-50 mg/kg 10-15 doses every other day. [4] In some cases, intercurrent bacterial infections occur that may then be treated with the appropriate antibiotic therapy (in the inpatient or outpatient setting).

For Opisthorchis infections, praziquantel 25 mg/kg 3 times a day for 2 days taken with liquids during a meal is the recommended treatment. [4] An open-label phase II trial found that tribendimidine had similar tolerability and efficacy to praziquantel against O viverrini. [46] In contrast, mefloquine, artesunate, and mefloquine-artesunate were not effective in the same trial and were associated with vertigo, nausea, vomiting, and anxiety. Further large-scale clinical trials are needed to identify the best role of tribendimidine; future data may support this drug as yet another potential treatment option.

For Clonorchis infections, praziquantel 25 mg/kg 3 times a day for 2 days taken with liquids during a meal is also the recommended treatment, although albendazole 10 mg/kg as a single dose for 7 days may also be used. [4]

The WHO states that all confirmed cases of fascioliasis, opisthorchiasis and clonorchiasis should be treated, as well as all suspected cases in endemic areas. [47]

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Diet

Proper cleaning and processing of raw vegetables by immersing in boiling water for a few seconds, followed by peeling and washing in clean water is important in preventing infection with intestinal flukes, especially in endemic areas.

The importance of thoroughly cooking contaminated vegetables cannot be overemphasized.

Do not eat raw or undercooked fish.

The diet in infected individuals should contain adequate protein.

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Activity

The patient should be on bed rest.

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