Which medications in the drug class Anthelmintics are used 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

Anthelmintics

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses. The effectiveness of anthelmintic agents against larvae is poor; they are more effective once established infection occurs.

Ivermectin (Stromectol, Mectizan)

Ivermectin is the drug of choice (DOC) for acute and chronic strongyloidiasis in intestinal stages, hyperinfection syndrome, and disseminated strongyloidiasis. This drug has not been studied extensively in children, and it has been used as an adjuvant in patients with hyperinfection not responding to thiabendazole.

Ivermectin is a semisynthetic derivative of the macrolide mold product avermectin that binds selectively to glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, thereby increasing the permeability of the cell membrane with hyperpolarization and causing paralysis and cell death.

Its half-life is 16 hour, and it is metabolized in the liver. The cure rate is 97% with 2-day course. Case reports have been made of successful SC injection of ivermectin in patients unable to achieve adequate serum drug levels after PO administration.

Albendazole (Albenza)

Albendazole is an alternative to ivermectin for the treatment of acute and chronic strongyloidiasis. This agent has high-affinity binding to free beta-tubulin in parasite cells—thereby inhibiting tubulin polymerization, which results in loss of cytoplasmic microtubules—and decreases ATP production in the worm, causing energy depletion (by inhibiting glucose uptake), immobilization, then death. To avoid an inflammatory response in central nervous system (CNS), administer albendazole with anticonvulsants and high-dose glucocorticoids.

Mebendazole

Mebendazole has variable efficacy against strongyloidiasis. This agent inhibits microtubule formation and causes worm glucose depletion and is available in chewable form for pediatric use.


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