Gnathostomiasis Medication

Updated: Apr 26, 2018
  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
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Medication

Medication Summary

Although surgical removal, when possible, is the treatment of choice in gnathostomiasis, albendazole appears to have an increasing role in complementing surgical intervention. [15] Ivermectin in a single dose is better tolerated than albendazole but may be less effective. [16] Mebendazole, which was formerly used, had variable results and due to significant toxicities should no longer be used. Adjunctive corticosteroid therapy, as an anti-inflammatory, may have a role in the treatment of CNS disease.

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Anthelmintics

Class Summary

These agents are the drugs of choice when surgical treatment is not possible or successful. 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 that 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

Albendazole (Albenza)

DOC for treating gnathostomiasis. A synthetic nitroimidazole that binds to tubulin, inhibits microtubule assembly, decreases glucose absorption, and inhibits fumarate reductase in the parasite. Poorly soluble in water, it is well absorbed when taken with a fatty meal. Concentration in the cerebrospinal fluid reaches 40% of that in the serum. Two treatment courses may be required.

Thiabendazole (Mintezol)

A synthetic benzimidazole that should be used only when albendazole is not available because of its toxicities and questionable efficacy. Its mechanism of action is thought to be similar to that of albendazole.

Ivermectin (Mectizan, Stromectol)

Binds selectively with glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing cell death. Half-life is 16 h; metabolized in liver.

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Corticosteroids

Class Summary

These agents may have an ancillary role in reducing inflammation associated with CNS gnathostomiasis.

Dexamethasone (Decadron, Dexone)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

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