Nematode Infections Medication

Updated: Jun 23, 2017
  • Author: Murat Hökelek, MD, PhD; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to eradicate the infestation, to reduce morbidity, and to prevent complications. [6]

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Anthelmintic agents

Class Summary

Parasite biochemical pathways are different from the human host; thus, toxicity is directed to the parasite, egg, or larvae. Mechanism of action varies within the drug class. Antiparasitic actions may include the following:

- Inhibition of microtubules, causing 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

Albendazole (Albenza)

Used for hookworm, pinworm, and roundworm. Decreases ATP production in worm, causing energy depletion, immobilization, and, finally, death.

Mebendazole (Vermox)

Indicated for treating E vermicularis (pinworm), T trichiura (whipworm), A lumbricoides (common roundworm), A duodenale (common hookworm), N americanus (American hookworm) in single or mixed infections. Efficacy varies as a function of such factors as preexisting diarrhea and GI transit time, degree of infection, and helminth strains. Causes worm death by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where helminths dwell.

Ivermectin (Mectizan)

Member of avermectin class (broad-spectrum antiparasitic agents). Unique mode of action. Binds selectively with high affinity to glutamate-gated chloride ion channels in invertebrate nerve and muscle cells. Increases permeability of cell membrane to chloride ions. Results in hyperpolarization of nerve or muscle cell, causing parasite paralysis and death. Also affects other ligand-gated chloride channels (eg, those gated by GABA). Active against various life-cycle stages of most nematodes. Active against O volvulus tissue microfilariae but not adult form. Activity against S stercoralis limited to intestinal stages.

Piperazine (Vermizine)

Readily absorbed from GI tract, partially degraded in vivo, and excreted in urine. Paralyzes worm muscle; thus, worm expelled by normal intestinal peristalsis. Exhibits wide therapeutic index. Not available in the United States.

Pyrantel pamoate (Antiminth, Pin-Rid)

Depolarizing neuromuscular blocking agent and cholinesterase inhibitor that results in spastic paralysis of worm. Active against E vermicularis (pinworm), A lumbricoides (roundworm), and A duodenale (hookworm).

Diethylcarbamazine citrate (Hetrazan)

Effective in treating filariasis specific for W bancrofti, B malayi, and L loa. Does not contain any toxic metallic elements. Not recommended as DOC because of severe adverse effects. Recommended if therapy with mebendazole fails or unavailable.

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