Which anthelmintic agents are indicated in the treatment of strongyloidiasis?

Updated: Jun 20, 2019
  • Author: Pranatharthi Haran Chandrasekar, MBBS, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

For acute and chronic strongyloidiasis, the CDC recommends ivermectin 200 μg/kg orally for 1-2 days as first-line therapy. Relative contraindications include concomitant Loa loa infection, weight less than 15 kg, pregnancy, and breastfeeding. Alternatively, albendazole 400 mg orally twice a day for one week can be given. Relative contraindications include hypersensitivity to benzimidazole compounds and first trimester of pregnancy. [72] A 2016 review of 7 trials found that ivermectin was more efficacious than albendazole and better tolerated than thiabendazole. Cure rates for ivermectin, albendazole, and thiabendazole were 74%-84%, 48%, and 69%, respectively. The main issue with thiabendazole was GI side effects. [73]

Patients with hyperinfection and disseminated disease should be treated with ivermectin 200 μg/kg per day orally until stool and/or sputum examination findings are negative for 2 weeks. Rectal administration is recommended for patients with malabsorption or who are unable to tolerate oral therapy. Every effort should be made to reduce or stop immunosuppressants in these patients. [72]

Patients in whom treatment fails to elicit a response should undergo screening for HTLV-1 infection. [74]


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