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Chapter 323. Antiparasitic Therapy

Melissa Held; Michael Cappello

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 Drug Therapy*
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Table 323-1. Antiparasitic Drug Therapy*
Drugs of Choice and Dosages
Nematodes
Intestinal nematodes
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 lumbricoidesAlbendazole 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 trichiuraMebendazole 100 mg by mouth twice a day for 3 days or 500 mg once
(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 stercoralisIvermectin 200 μg/kg/day by mouth for 2 days
(Alternative) Albendazole 400 mg by mouth twice a day for 7 days
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
Blood and tissue nematodes
Wuchereria bancrofti, Brugia malayi, Loa loa (Filariasis)Diethylcarbamzine 6 mg/kg/day by mouth in 3 doses for 12 days
Mansonella ozzardiIvermectin 200 μg/kg by mouth once
Mansonella perstansAlbendazole 400 mg by mouth twice a day for 10 days
(Alternative) Mebendazole 100 mg by mouth ...

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