| 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 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
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 stercoralis | Ivermectin 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 ozzardi | Ivermectin 200 μg/kg by mouth once |
Mansonella perstans | Albendazole 400 mg by mouth twice a day for 10 days |
(Alternative) Mebendazole 100 mg by mouth twice a day for
30 days |
Mansonella streptocerca | Ivermectin 150 μg/kg by mouth once or Diethylcarbamazine
6 mg/kg/day by mouth for 12 day |
Onchocerca volvulus (river blindness) | Ivermectin 150 μg/kg by mouth once,
repeat every 6–12 months until asymptomatic |
Capillaria philippinensis | Mebendazole 200 mg by mouth twice a day for 20 days |
(Alternative) Albendazole 400 mg by mouth daily for 10 days |
Ancylostoma braziliense, A caninum | Thiabendazole (topical) or (cutaneous larva migrans, creeping
eruption) Albendazole 400 mg by mouth daily for 3 days or Ivermectin
200 μg/kg by mouth daily for 1–2
days |
Toxocara canis, Toxocara cati (Visceral
and ocular larva migrans) | Albendazole 400 mg by mouth twice a day for 5 days or Mebendazole
100–200 g by mouth twice a day for 5 days |
Dracunculus medinensis (Guinea worm) | Slow extraction of worm combined with wound care.** Metronidazole
decreases inflammation and facilitates removal of the worm. Mebendazole
can kill worm directly. |
Cestodes |
Intestinal
(adult) tapeworms |
Diphyllobothrium latum, Taenia
saginata, Taenia solium, Dipylidium
caninum | Praziquantel 5–10 mg/kg by mouth once |
(Alternative) Niclosamide 2 g by mouth once |
Hymenolepis nana | Praziquantel 25 mg/kg by mouth once |
(Alternative) Nitazoxanide 500 mg by mouth once daily for
3 days or twice a day for 3 days |
Tissue (larval)
tapeworms |
Echinococcus granulosis, Echinococcus
multilocularis | Albendazole 400 mg by mouth twice a day for 1–6
months (surgical excision for E multilocularis may
be the only reliable treatment) |
T solium (cysticercosis) | Initial treatment should focus on symptomatic treatment. |
Albendazole 400 mg by mouth twice a day for 8–30
days; may repeat or Praziquantel 100 mg/kg/day
by mouth in 3 doses for 1 day then 50 mg/kg/day
in 3 doses for 29 days |
T solium (Neurocysticercosis) | Albendazole (same dose as for cysticercosis) plus steroids
plus antiseizure medication if live cysts or Praziquantel
is 100 mg/kg/day in 3 doses for 1 day, followed
by 50 mg/kg/day in 3 doses for 29 days |
Trematodes |
Schistosoma haematobium, Schistosoma
mansoni | Praziquantel 40 mg/kg/day by mouth in 2
doses for 1 day |
(Alternative drug for S mansoni is oxamniquine
at 15 mg/kg by mouth once) |
Schistosoma japonicum, Schistosoma
mekongi | Praziquantel 60 mg/kg/day by mouth in 3
doses for 1 day |
Clonorchis sinensis (Chinese liver fluke) | Praziquantel 75 mg/kg/ day by mouth in
3 doses for 1 day or 25 mg/kg 3 times for 2 days or single
40 mg/kg or Albendazole 10 mg/kg/day
by mouth for 7 days |
Fasciola hepatica (sheep
liver fluke) | Triclabendazole 10 mg/kg by mouth once or twice |
(Alternative) Bithionol (not available in United States)
30–50 mg/kg on alternate days for 10–15 doses or Nitazoxanide
500 mg by mouth twice a day for 7 days |
Fasciolopsis buski, Heterophyes
heterophyes | Praziquantel 25 mg/kg by mouth once |
Metagonimus yokogawai (intestinal flukes) | |
Metorchis conjunctus | |
Nanophyetus salmincola | Praziquantel 60 mg/kg/day by mouth in 3
doses for 1 day |
Opisthorchis viverrini | Praziquantel 75 mg/kg/day by mouth in 3
doses for 2 days |
Paragonimus westermani (lung fluke) | Praziquantel 75 mg/kg/day by mouth in 3
doses for 2 days |
| (Alternative) Bithionol (not available in United States)
30–50 mg/kg on alternate days for 10–15 doses |
Protozoa |
Intestinal
protozoa |
Entamoeba histolytica (amebiasis) | |
Asymptomatic | Iodoquinol 650 mg by mouth 3 times a day for 20 days or Paromomycin
25–35 mg/kg/day by mouth in 3 doses for
7 days or diloxanide furoate 500 mg by mouth 3
times a day for 10 days |
Mild to moderate disease or severe intestinal and extraintestinal | Metronidazole 500–750 mg by mouth 3 times a day
for 7–10 days (or 35–50 mg/kg/day
by mouth in 3 doses for 7–10 days) or Tinidazole
2 g once by mouth daily for 3 days (over 3 years of age use 50 mg/kg/day,
max 2 g, by mouth in 1 dose for 3 days) either followed
by Iodoquinol 650 mg by mouth 3 times a day for 20 days (or 30–40
mg/kg/day, max 2 g, by mouth in 3 doses for 20
days) or Paromomycin 25–35 mg/kg/day
by mouth in 3 doses for 7 days |
Entamoeba polecki | Metronidazole 500–750 mg by mouth 3 times a day
for 7–10 days (or 35–50 mg/kg/day
by mouth in 3 doses for 7–10 days) |
Balantidium coli | Tetracycline 500 mg by mouth in 4 doses for 10 days (or 40
mg/kg/day, max 2 g, by mouth in 4 doses for 10
days) |
(Alternative) Iodoquinol 650 mg by mouth 3 times a day for
20 days (or 30–40 mg/kg/day, max 2 g,
by mouth in 3 doses for 20 days) or Metronidazole
750 mg by mouth 3 times a day for 5 day (or 35–50 mg/kg/day
by mouth in 3 doses for 5 days) |
Dientameba fragilis | Iodoquinol 650 mg by mouth 3 times a day for 20 days (or
30–40 mg/kg/day, max 2 g, by mouth in 3
doses for 20 days) or Paromomycin 25–35
mg/kg/day by mouth in 3 doses for 7 days or Tetracycline
500 mg by mouth in 4 doses for 10 days (or 40 mg/kg/day,
max 2 g, by mouth in 4 doses for 10 days) or Metronidazole
500–750 mg by mouth 3 times a day for 10 days (or 35–50
mg/kg/day by mouth in 3 doses for 10 days) |
Giardia duodenalis | Metronidazole 250 mg by mouth 3 times a day for 5–7
days (or 15 mg/kg/day by mouth in 3 doses for 5-7
days) or Nitazoxamide 500 mg by mouth twice a day
for 3 days (if 1–3 years use 100 mg by mouth every 12 h
for 3 days, if 4–11 years use 200 mg by mouth every 12
h for 3 days) or Tinidazole 2 g by mouth once (or
50 mg/kg by mouth once) |
(Alternative) Paromomycin 25–35 mg/kg/day
by mouth in 3 doses for 5–10 days or Quinacrine 100
mg by mouth 3 times a day for 5 days (or 2 mg/kg/day
by mouth in 3 doses for 5 days) or Furazolidone
100 mg by mouth in 4 doses for 7–10 days (or 6 mg/kg/day
by mouth in 4 doses for 7–10 days) |
Cryptosporidium | Nitazoxanide 500 mg by mouth twice a day for 3 days (1–3
years 100 mg by mouth twice a day for 3 days; 3–11 years
200 mg by mouth twice a day for 3 days) |
Microsporidiosis |
Encephalitozoon intestinalis | Albendazole 400 mg by mouth twice a day for 21 days |
Enterocytozoon bieneusi | Fumagillin 20 mg by mouth 3 times a day for 14 days |
Ocular (Encephalitozoon hellum, Encephalitozoon
cuniculi, Vittaforma corneae) | Albendazole 400 mg by mouth twice a day plus Fumagillin |
Malaria (See Chapter 352 and Tables 352-2, 352-3, and 352-4.) |
Other Blood and
Tissue Protozoa |
Naegleria species, Acanthamoeba species (amebic
meningoencephalitis) | Amphotericin B 1.5 mg/kg/day IV in 2 doses
for 3 days, then 1 mg/kg/day for 6 days plus 1.5
mg/day intrathecally for 2 days, then 1 mg/day
every other day for 8 days |
Babesia species (Babesiosis) | Clindamycin 1.2 g twice a day IV or 600 mg 3 times a day
by mouth for 7–10 days plus Quinine 650 mg by mouth 3 times
a day for 7–10 days or Atovaquone 750
mg by mouth twice a day for 7–10 days plus Azithromycin
600 mg by mouth daily for 7–10 days |
Toxoplasma gondii (Toxoplasmosis) | Pyrimethamine 25–100 mg/day by mouth for
3–4 weeks plus Sulfadiazine 1–1.5 g by mouth 4
times a day for 3–4 weeks |
Trypanosoma brucei gambiense | |
Hemolymphatic stage | Pentamidine isethionate 4 mg/kg/day IM
for 7 days; (Alternative) Suramin |
Late stage | Melarsoprol 2.2 mg/kg/day IV for 10 days or Eflornithine
400 mg/kg/day IV in 4 doses for 14 days |
Trypanosoma brucei rhodesiense | |
Hemolytic stage | Suramin 100–200 mg (test dose) IV, then 1 g IV on
days 1, 3, 7, 14, 21 |
Late stage | Melarsoprol 2–3.6 mg/kg/day IV
for 3 days, after 7 days 3.6 mg/kg/day for 3 days;
repeat after 7 days |
Trypanosoma cruzi (American trypanosomiasis or
Chagas disease) | Nifurtimox 8–10 mg/kg/day by mouth
in 3–4 doses for 90–120 days (1–10 years
use 15–20 mg/kg/day by mouth in 4 doses
for 90–120 days; 11–16 years use 12.5–15
mg/kg/days in 4 doses for 90–120 days) or Benzimidazole
5–7 mg/kg/day by mouth in 2 doses for
30–90 days (< 12 years use 10 mg/kg/day
by mouth in 2 doses for 30–90 days) |
Leishmania mexicana, Leishmania
major | |
Leishmania tropica, Leishmania braziliensis, Leishmania
donovani, Leishmania infantum | |
Cutaneous | Sodium stibogluconate 20 mg Sb/kg/day IV
or IM for 20 days or Meglumine antimonate 20 mg Sb/kg/day
IV or IM for 20 days or Miltefosine 2.5 mg/kg/day
by mouth (max 150 mg/day) for 28 days |
(Alternative) Paromomycin topically twice a day for 10–20
days or Pentamidine 2–3 mg/kg IV
or IM daily or every second day for 4–7 doses |
Visceral | Sodium stibogluconate or liposomal Amphotericin
B 3 mg/kg/day IV day 1–5, 14 and 21 or Miltefosine |
(Alternative) Meglumine antimonate (above) or Amphotericin
B 1 mg/kg IV daily for 15–20 days or every second
day for up to 8 weeks or Paromomycin 15 mg/kg/day
IM for 21 days |
Mucosal | Sodium stibogluconate or Meglumine antimonate or Amphotericin
B or Miltefosine (see treatments above) |
Ectoparasites |
Lice (Pediculus humanus, Pediculus
humanus capitis,Phthirus pubis) | 1% Permethrin or 0.5% Malathion
(both topically) |
(Alternative) Pyrethrins with piperonyl butoxide or Ivermectin
200 μg/kg by mouth |
Scabies (Sarcoptes scabiei) | 5% Permethrin (topically) |
(Alternative) Ivermectin or 10% Crotamiton |