Trichinellosis/Trichinosis Medication

Updated: Nov 06, 2015
  • Author: L Kristian Arnold, MD, MPH; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Medication

Medication Summary

Anthelminthic therapy is generally considered only effective during the intestinal phase of infection. Because of the limited number of cases in any one outbreak, comparative trials at various stages of infection are lacking, leading to controversy regarding appropriate dosing and effectiveness in the muscle phase of the disease. [68] One trial during an outbreak in Italy assessed the effectiveness of mebendazole in patients several weeks following infection. [69] All patients became better in terms of decreased myalgias and other symptoms while under treatment, but between 3 and 45% had recurrence of various symptoms following a 10-day mebendazole course. In another study in Thailand, groups treated with mebendazole or thiabendazole had 100% resolution of myalgias reported at 4 months. [28] A review of experience in Romania revealed a better response among children with albendazole than in adults and a better result in both children and adults with albendazole than mebendazole. [70, 71]

Corticosteroid treatment usually is instituted to reduce the immunologic response to the larvae. Jarisch-Herxheimer–like reactions have been described in patients with heavy larval loads following the administration of anthelmintic medications. This reaction is clinically manifested by a worsening of symptoms and is thought to be caused by a response to liberation of immunologically active components of the dying larvae. If the larval load is extremely high or in critical locations, this reaction may result in significant clinical deterioration resembling septic shock.

In the study in Romania, patients treated with corticosteroids and albendazole experienced longer hospitalizations than those treated with albendazole alone. The study does not specify what clinical parameters were used to determine timing of hospital discharge because it was a retrospective population study. A different study of an outbreak in Turkey due to T britovi reported more rapid improvement in symptoms and laboratory values in patients given prednisolone along with either mebendazole or albendazole. [72]

Increasing resistance to helminths has led to investigation of potential new treatments. Investigators have demonstrated activity of different Artemisia species, effective against malaria, on Trichinella in animal models. [73]

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Glucocorticoids

Class Summary

These agents are frequently used to decrease myalgia and to limit eosinophilia when neurologic or myocardial involvement is present, although their efficacy and safety has been questioned. [4]

Prednisone (Deltasone, Orasone)

Useful in treating inflammatory reactions. May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

Hydrocortisone (Solu-Cortef, Westcort)

May be used in place of prednisone in patients too ill to take PO medications. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing the increased capillary permeability.

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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.

Mebendazole (Vermox)

Causes worm death by selectively and irreversibly blocking cell division and intestinal glucose uptake and in the adult.

Albendazole (Albenza)

Decreases ATP production in the worm, causing worms' energy depletion, immobilization, and death.

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