Ascaris Lumbricoides Treatment & Management

Updated: May 18, 2016
  • Author: Aaron Dora-Laskey, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Treatment

Emergency Department Care

Early infection (larval migration)

Inhaled beta-agonists may be indicated.

Steroids for pulmonary symptoms are controversial.

Whether anthelmintic therapy is effective against larval stages is unclear. (Stool ova microscopy will likely be negative at this phase). Because infection in the early phase is rarely serious, generally treatment is delayed until definitive diagnosis can be made.

Established infection (adult phase)

Benzimidazoles are the mainstay of treatment of symptomatic and asymptomatic infections. They are poorly systemically absorbed and thus have low human toxicity and exert their action directly on worms. The most common members of this family are albendazole and mebendazole.

Treatment of bowel obstruction includes intravenous hydration, nasogastric suctioning, electrolyte monitoring, and laparotomy if conservative measures fail. Colonoscopy and esophagogastroduodenoscopy (EGD) may be useful in removing obstructing masses of worms.

Piperazine citrate, a helminth paralytic, has been suggested in cases of obstruction; however, it is no longer commercially available in the United States.

Hepatobiliary ascariasis typically responds to similarly conservative therapy, but it may require invasive intervention (eg, ERCP) should this fail, or if there are coexisting stones or strictures. It may also be indicated in cases of pyogenic cholangitis and acute pancreatitis.

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Consultations

Bowel or hepatobiliary obstruction may require surgical or gastroenterologic consultation.

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