Strongyloidiasis Medication

Updated: Nov 04, 2016
  • Author: Pranatharthi Haran Chandrasekar, MBBS, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy in strongyloidiasis are to eradicate the infection, reduce morbidity, and prevent complications.

Several anthelmintic drugs are available for established infection. Thiabendazole was a therapeutic option for strongyloidiasis but has been discontinued. Albendazole and mebendazole have been used in patients with Strongyloides stercoralis infection, but results have varied. Ivermectin has been shown to be more effective than albendazole.

Patients with hyperinfection and disseminated disease should be treated with ivermectin. For those too sick to tolerate or absorb oral (PO) ivermectin, rectal (PR) or subcutaneous (SC) dosing may be effective. [73] In these patients, ivermectin should be administered daily until symptoms have resolved and larvae have not been detected for at least 2 weeks.

More information regarding the medications listed in this section may be obtained from The Centers for Disease Control and Prevention (CDC) as follows (contact information updated on November 3, 2010):

CDC Drug Service

1600 Clifton Road, MS/D09

Atlanta, GA 30333

Telephone: (404) 639-3670

Fax: (404) 639-3717

E-mail: drugservice@cdc.gov

Website: http://www.cdc.gov/laboratory/drugservice/

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Anthelmintics

Class Summary

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses. The effectiveness of anthelmintic agents against larvae is poor; they are more effective once established infection occurs.

Ivermectin (Stromectol, Mectizan)

Ivermectin is the drug of choice (DOC) for acute and chronic strongyloidiasis in intestinal stages, hyperinfection syndrome, and disseminated strongyloidiasis. This drug has not been studied extensively in children, and it has been used as an adjuvant in patients with hyperinfection not responding to thiabendazole.

Ivermectin is a semisynthetic derivative of the macrolide mold product avermectin that binds selectively to glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, thereby increasing the permeability of the cell membrane with hyperpolarization and causing paralysis and cell death.

Its half-life is 16 hour, and it is metabolized in the liver. The cure rate is 97% with 2-day course. Case reports have been made of successful SC injection of ivermectin in patients unable to achieve adequate serum drug levels after PO administration.

Albendazole (Albenza)

Albendazole is an alternative to ivermectin for the treatment of acute and chronic strongyloidiasis. This agent has high-affinity binding to free beta-tubulin in parasite cells—thereby inhibiting tubulin polymerization, which results in loss of cytoplasmic microtubules—and decreases ATP production in the worm, causing energy depletion (by inhibiting glucose uptake), immobilization, then death. To avoid an inflammatory response in central nervous system (CNS), administer albendazole with anticonvulsants and high-dose glucocorticoids.

Mebendazole

Mebendazole has variable efficacy against strongyloidiasis. This agent inhibits microtubule formation and causes worm glucose depletion and is available in chewable form for pediatric use.

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