Pediatric Cutaneous Larva Migrans Medication

Updated: Nov 18, 2022
  • Author: Theresa M Fiorito, MD, MS, FAAP, CTH®; Chief Editor: Russell W Steele, MD  more...
  • Print


Class Summary

Anthelmintics are the drug of choice for cutaneous larva migrans (CLM). Parasite biochemical pathways are different from the human host; thus, toxicity is directed to the parasite, egg, or larvae. 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

Ivermectin (Stromectol)

Broad-spectrum anthelmintic that is not FDA approved for the treatment of CLM but is suggested as DOC by many studies. Single-dose therapy makes this drug convenient. Available in the United States because of FDA approval for treatment of onchocerciasis and strongyloidiasis. Selectively binds with glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing cell death. Half-life is 16 h; metabolized in liver. Available in 3 mg tabs.

Albendazole (Albenza)

Broad-spectrum antihelminthic drug used in nematode and cestode infestations; not FDA approved for treatment of CLM but has been shown by many studies to be highly effective with no or minimal adverse effects. Available in the United States because of FDA approval for treatment of hydatid disease and neurocysticercosis. Decreases ATP production in worm, causing energy depletion, immobilization, and, finally, death.

Thiabendazole (Mintezol)

Standard treatment of CLM has been topical thiabendazole; however, high rate of relapse is noted. Also, with less common causes due to human nematodes, does not prevent development of systemic illness or eliminate intestinal reservoir. PO thiabendazole is only FDA-approved drug for treatment of CLM. Therapy with PO formulation has been fraught with adverse effects.

Mebendazole (Vermox)

Causes worm death by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where helminths dwell.