Medication Summary
The drug of choice for trichuriasis is mebendazole. A single 500-mg dose can result in a cure rate of 40-75%. Albendazole is an alternative drug. However, its efficacy for trichuriasis is slightly lower than for mebendazole. [5, 6]
Recent studies have shown combination therapy with Ivermectin and Albendazole has higher cure rates than monotherapy with Albendazole alone. [22]
Oxantel pamoate (not currently available in the United States) has shown efficacy in the treatment of trichuriasis. Using oxantel pamoate in combination with either mebendazole or albendazole results in a much higher cure rate than monotherapy.
Emodepside, a veterinary drug, has shown superior activity against trichuria when compared to Albendazole. It is currently being studied as a leading therapeutic candidate to treat trichuriasis and other helminth infections. [23]
Anthelmintic agents
Class Summary
Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.
Mebendazole (Emverm)
Causes worm death by selectively and irreversibly blocking glucose uptake and other nutrients in the susceptible adult intestine where helminths dwell. Available as a 100-mg chewable tablet that can be swallowed whole, chewed, or crushed and mixed with food.
Administer a second course if patient is not cured within 3-4 wk.
Albendazole (Albenza)
Decreases whipworm ATP production, causing energy depletion, immobilization, and death.
Anthelmintics
Ivermectin (Stromectol)
Increases nerve and muscle cell membrane permeability when it binds to chloride ion channels causing paralysis and subsequent death of parasite
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This is an illustration of the life cycle of Trichuris trichiura, the causal agent of trichuriasis. Image courtesy of Centers for Disease Control and Prevention, Alexander J. da Silva, PhD, and Melanie Moser.
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Adult Trichuris trichiura males are 30-45 mm long, with a coiled posterior end. Adult females are 35-50 mm with a straight posterior end. Both sexes have a long, whip-like anterior end. Adults reside in the large intestine, cecum, and appendix of the host. Image shows the posterior end of an adult T trichiura, taken during a colonoscopy. Image courtesy of Duke University Medical Center and Centers for Disease Control and Prevention.
