Fascioliasis Medication

Updated: Oct 11, 2019
  • Author: Harbir Singh Arora, MD; Chief Editor: Russell W Steele, MD  more...
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Medication

Medication Summary

New fasciolicides are being used in small numbers of children with encouraging results and minimal toxicities. Triclabendazole is the drug of choice and was approved in the United States in 2019 after being available from the CDC for many years. [37] On the basis of limited data from the CDC, nitazoxanide might be effective therapy in some patients. Praziquantel, which is active against most trematodes (flukes), typically is not active against Fasciola parasites. Therefore, the CDC does not recommend praziquantel therapy for fascioliasis. [38]

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Anthelmintics

Class Summary

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

- Inhibition of microtubules causes 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

Triclabendazole (Egaten)

Triclabendazole is an anthelmintic agent. The mechanism by which triclabendazole exhibits its effect against Fasciola species is not fully elucidated. Studies in vitro and/or in infected animals suggest that triclabendazole and its active metabolites (sulfoxide and sulfone) are absorbed by the tegument of the immature and mature worms, leading to a decrease of the resting membrane potential, inhibition of tubulin function, and inhibition of protein and enzyme synthesis. It is indicated for treatment of fascioliasis in patients aged 6 years or older.

Nitazoxanide (Alinia)

Limited data suggest nitazoxanide might be effective therapy in some patients. It interferes with pyruvate:ferredoxin oxidoreductase (PFOR), essential to anaerobic energy metabolism.

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Corticosteroids

Class Summary

Corticosteroids may ameliorate the treatment course in children with severe acute phase infection.

Prednisolone (Pediapred, Delta-Cortef, Econopred)

A short course that is given for 2 d preceding fasciolicidal therapy in children with severe acute phase infection is reported anecdotally to ameliorate the course of the illness and to decrease fever, pain, pruritus, and toxicity.

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