Parasitic diseases afflict more
than 2 billion people worldwide and are among the leading causes of
death and chronic morbidity in resource-limited countries. Because
parasites collectively represent a wide array of species, effective
therapy of infections caused by these evolutionarily distinct eukaryotes
requires an equally diverse armamentarium of pharmacologic agents.
The past decade has seen a renewed commitment to antiparasitic drug
development, spearheaded by novel public-private partnerships and
supported by international philanthropic organizations, a commitment
that may ultimately yield new agents for these globally important
diseases.1-3 Equally encouraging is the recent
recognition that integrated control of multiple tropical diseases can
be achieved through periodic administration of inexpensive, orally
available medicines to at-risk individuals living in endemic communities.4,5
Table 323-1 lists the major parasitic
species that cause disease in humans along with the currently recommended
drugs and doses used for therapy or prevention.6 Antimalarial
therapy is discussed in Chapter 352, and detailed
in Tables 352-2, 352-3, and 352-4.
Below are brief descriptions of these agents, including common side effects
and toxicities. More specific information is available in the chapters
on each pathogen.
Table 323-1. Antiparasitic
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Table 323-1. Antiparasitic
|Drugs of Choice and Dosages|
|Ancylostoma duodenale, Ancylostoma
caninum, Necator americanus (hookworm)||Albendazole 400 mg by mouth once or Pyrantel
pamoate 11 mg/kg (max 1 g) by mouth 3 times a day or Mebendazole
100 mg by mouth twice a day for 3 days or 500 mg once|
|Ascaris lumbricoides||Albendazole 400 mg by mouth once or Mebendazole
100 mg twice a day by mouth for 3 days or 500 mg once or Ivermectin
150–200 μg/kg by mouth once|
|Trichuris trichiura||Mebendazole 100 mg by mouth twice a day for 3 days or 500
|(Alternatives) Albendazole 400 mg by mouth for 3 days or Ivermectin
200 μg/kg by mouth daily for 3 days|
|Enterobius vermicularis (pinworm)||Pyrantal pamoate 11 mg/kg base by mouth once (max
1 g); repeat in 2 weeks or Albendazole 400 mg by
mouth once; repeat in 2 weeks or Mebendazole 100
mg by mouth once; repeat in 2 weeks|
|Strongyloides stercoralis||Ivermectin 200 μg/kg/day
by mouth for 2 days |
|(Alternative) Albendazole 400 mg by mouth twice a day for
|Trichinella spiralis (Trichinosis)||Albendazole 400 mg by mouth twice a day for 8–14
days or Mebendazole 200–400 mg by mouth 3
times a day for 3 days, then 400–500 mg 3 times a day for
10 days plus steroids for severe symptoms|
|Wuchereria bancrofti, Brugia malayi, Loa
loa (Filariasis)||Diethylcarbamzine 6 mg/kg/day by mouth
in 3 doses for 12 days|
|Mansonella ozzardi||Ivermectin 200 μg/kg by mouth once|
|Mansonella perstans||Albendazole 400 mg by mouth twice a day for 10 days|
|(Alternative) Mebendazole 100 ...|
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