TABLE 53–1 Drugs for the treatment of helminthic infections.1 1Additional information may be obtained from the Parasitic Disease Drug Service, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, 30333. Telephone: (404) 639-3670. Some of the drugs listed are not generally available in the USA.
is a single dose of 400 mg orally (repeated daily for 2–3 days for heavy infections and in 2 weeks for pinworm infections).
Albendazole is administered on an empty stomach when used These treatments typically achieve good cure rates and marked against intraluminal parasites but with a fatty meal when used reduction in egg counts in those not cured. For hookworm against tissue parasites.
infections and trichuriasis, albendazole at 400 mg orally once 1. Ascariasis, trichuriasis, and hookworm and pinworm daily for 3 days is now recommended, with albendazole showing infections—For adults and children older than 2 years with improved efficacy over mebendazole. For trichuriasis, combinaascariasis and pinworm infections, the treatment for ascariasis tion of either mebendazole or albendazole with ivermectin and combination of albendazole with oxantel pamoate markedly improved treatment outcomes.
2.
Hydatid disease—Albendazole is the treatment of choice for medical therapy and is a useful adjunct to surgical removal or aspiration of cysts. It is more active against Echinococcus granulosus than against Echinococcus multilocularis. Dosing is 400 mg twice daily with meals for 1 month or longer. Daily therapy for up to 6 months has been well tolerated. One reported therapeutic strategy is to treat with albendazole and praziquantel, to assess response after 1 month or more, and, depending on the response, to then manage the patient with continued chemotherapy or combined surgical and drug therapy.
3.
Neurocysticercosis—Indications for medical therapy for neurocysticercosis are controversial, since antihelminthic therapy is not clearly superior to therapy with corticosteroids alone and may exacerbate neurologic disease. Therapy is probably most appropriate for symptomatic parenchymal or intraventricular cysts. Corticosteroids are usually given with the antihelminthic drug to decrease inflammation caused by dying organisms. Albendazole is now generally considered the drug of choice over praziquantel because of its shorter course, lower cost, improved penetration into the subarachnoid space, and increased drug levels (as opposed to decreased levels of praziquantel) when administered with corticosteroids. Albendazole is given in a dosage of 400 mg twice daily for up to 21 days. Albendazole combined with praziquantel improves efficacy in patients with multiple brain cysts.
4.