Parasitic infections are an important cause of morbidity and mortality worldwide. Parasitic infections occur primarily in the tropical and subtropical areas; nevertheless, due to international travel and immigration, they are becoming important for healthcare practitioners all over the globe. The world of antiparasitic medications can be confusing. Some of the antiparasitic agents are not approved by the US Food and Drug Administration (FDA), and others are approved only for specific indications in children. A few antiparasitic drugs are only available through the Centers for Diseases Control and Prevention (CDC). Several new antiparasitic drugs have become available, and their effectiveness has been determined by their use in countries with endemic infections. Cooperation among governmental and private institutions has made a big impact in helping eradicate or diminish the incidence of parasitic infections in areas with extremely limited resources. Antiparasitic therapy for specific pathogens still could be challenging due to the lack of strong evidence supporting the use for a certain indication. The most recent recommendations for the management of parasitic infections are provided in Tables 318-1, 318-2, 318-3, 318-4, 318-5 including recommended drugs and dosages for specific parasitic infections. Therapy for malaria is discussed in Chapter 347. The CDC also provides a consultation service for healthcare professionals to assist with the management of parasitic infections by phone, Monday through Friday, 7:30 AM to 4:00 PM EST (1-404-718-4745; after-hours emergencies 1-770-488-7100; email: firstname.lastname@example.org).
TABLE 318-1THERAPY FOR NEMATODE INFECTIONS ||Download (.pdf) TABLE 318-1THERAPY FOR NEMATODE INFECTIONS
|Infection Site/Microorganism ||Drugs of Choice and Dosages ||Comments |
|Intestinal nematodes |
|Hookworms || || |
Albendazolea,b 400 mg PO once;
OR mebendazole 100 mg PO for 3 days or 500 mg PO once;
OR pyrantel pamoatea,c 11 mg/kg PO QD for 3 days (max 1 g/d)
|A repeat dose of albendazole may be necessary. |
| Ancylostoma caninum ||Albendazolea,b 400 mg PO once ||May be a cause of eosinophilic colitis. |
First line: albendazolea,b 400 mg PO once;
OR mebendazole 500 mg PO once or 100 mg TID for 3 days
Pregnant women: pyrantel pamoatea,c 11 mg/kg PO once (max 1 g/d)
Alternatives: ivermectina,d 150–200 μg/kg PO once; nitazoxanidea 7.5 mg/kg PO once
Test of cure after therapy is not necessary.
|Albendazoleb 50 mg/kg/d PO divided BID for 20 days AND high-dose corticosteroid therapy for CNS infection || |
Albendazole 25 mg/kg/d PO daily for 20 days can be considered for prevention in children with known exposure (ingestion of raccoon stool or contaminated soil).
Ivermectin may be used in the interim if albendazole is not readily available.
Mebendazole 100 mg PO BID for 3 days or 500 mg once;
OR albendazolea,b 400 mg PO for 3 days;
OR ivermectina,c 200 μg/kg/d PO daily for 3 days;