Ascariasis treatment

Piperazine is an alternative drug and is used for treatment of various forms of nematodes, in particular for enterobiasis and ascariasis. It causes paralysis in the nematode by blocking acetylchohne transmission. This causes the parasite to detach from the mucous membrane, where it is removed from the body. Ascariasis requires treatment for 2 days, and enterobiasis, for 7 days. Synonyms of this drug are tasnon, uvilon, antepar, bexin, and many others. 

Piperazine is an appropriate alternative to mebendazole for the treatment of ascariasis, especially in the presence of intestinal or biliary obstruction. Cure rates of more than 80% are obtained following a 2-day regimen. 

Mebendazole is used primarily for the treatment of A. lumbricoides, T. trichiura, E. vermicularis, and hookworm infections, in which it produces high cure rates. It is an alternative agent for the treatment of trichinosis and visceral larva migrans. Owing to its broad-spectrum anthelmintic effect, mixed infections (ascariasis, hookworm infestation, or enterobiasis in association with trichuriasis) frequently respond to therapy. High doses have been used to treat hydatid disease, but albendazole is now thought to be superior. 

D. In the United States intestinal helminths produce mild disease with nonspecific findings. Piperazine or pyrantel pamoate may be used for the treatment of ascariasis. Mebendazole is an effective drug to be taken for 3 days. Thiabendazole is not used in this condition but is used commonly in strongyloidiasis. Albendazole at a single dose of 400 mg is the preferred mode of therapy. It is a... 

Albendazole, a broad-spectrum oral antihelminthic, is the drug of choice and is approved in the USA for treatment of hydatid disease and cysticercosis. It is also used in the treatment of pinworm and hookworm infections, ascariasis, trichuriasis, and strongyloidiasis. 

Piperazine is an alternative for the treatment of ascariasis, with cure rates over 90% when taken for 2 days, but it is not recommended for other helminth infections. Piperazine is available as the hexahydrate and as a variety of salts. It is readily absorbed, and maximum plasma levels are reached in 2-4 hours. Most of the drug is excreted unchanged in the urine in 2-6 hours, and excretion is complete within 24 hours. 

For ascariasis, the dosage of piperazine (as the hexahydrate) is 75 mg/kg (maximum dose, 3.5 g) orally once daily for 2 days. For heavy infections, treatment should be continued for 3-4 days or repeated after 1 week. 

For ascariasis, a single dose yields cure rates of 85-100%. Treatment should be repeated if eggs are found 2 weeks after treatment. For hookworm infections, a single dose is effective against light infections but for heavy infections, especially with N americanus, a 3-day course is necessary to reach 90% cure rates. A course of treatment can be repeated in 2 weeks. 

Juan, J.O., Lopez Chegne, N., Gargala, G. and Favennec, L. (2002) Comparative clinical studies of nitazoxanide, albendazole and praziquantel in the treatment of ascariasis, trichuriasis and hymenolepiasis in children from Peru. Transactions of the Royal Society of Tropical Medicine and Hygiene 96, 1 93-1 96. 

In the USA, mebendazole has been approved for use in ascariasis, trichuriasis, and hookworm and pinworm infection. It can be taken before or after meals the tablets should be chewed before swallowing. For pinworm infection, the dose is 100 mg once, repeated at 2 weeks. For ascariasis, trichuriasis, hookworm, and trichostrongylus infections, a dosage of 100 mg twice daily for 3 days is used for adults and for children over 2 years of age. Cure rates are 90-100% for pinworm infections, ascariasis, and trichuriasis. Cure rates are lower for hookworm infections, but a marked reduction in the worm burden occurs in those not cured. For intestinal capillariasis, mebendazole is used at a dosage of 400 mg/d in divided doses for 21 or more days. In trichinosis, limited reports suggest efficacy against adult worms in the intestinal tract and tissue larvae. Treatment is three times daily, with fatty foods, at 200-400 mg per dose for 3 days and then 400-500 mg per dose for 10 days. Corticosteroids should be coadministered for severe infections. 

Levamisole hydrochloride is used in the treatment of helminth infections and as an adjuvant in malignant disease. It is active against intestinal nematode worms and appears to act by paralyzing and eliminating susceptible worms. It has proven valuable in the treatment of ascariasis and hookworm infections. The use of levamisole should be avoided in patients with preexisting blood disorders. 

Jessen, K., A1 Mofleh, I., AI Moferreh, M. Endoscopic treatment of ascariasis causing acute obstructive cholangitis. Hepatogastroenterol. 1986 33 275-277... 

The efficacy of 2 years of mass chemotherapy against ascariasis has been evaluated in Iran (5). A single dose of albendazole 400 mg was given at 3-month intervals for 2 years to every person, except children under 2 years of age and pregnant women. After 2 years of treatment the prevalences, based on 2667 post-treatment samples, had fallen (Table 1). There were no adverse effects of mass treatment with albendazole. 

Treatment of ascariasis with a single oral dose of levamisole 2.5 mg/kg is effective, with evidence of toxicity in under 1% of patients. 

In both adults and pediatric patients older than 2 years of age, the treatment for ascariasis is mebendazole (Vermox) 100 mg twice daily... 

The drug and pure santonin are used in paediatric medicine for treatment of ascariasis. 

Piperazine (single dose of 3.5 g for two consecutive days) is indicated in the treatment of enterobiasis (pinworm infection) and ascariasis (roundworm infection). 

Like mebendazole, albendazole provides safe and effective therapy against infections with GI nematodes, including mixed infections of Ascaris, Trichuris, and hookworms. For treatment of enterobiasis, ascariasis, trichuriasis, and hookworm, albendazole is taken as a single oral 400-mg dose by adults and children >2 years of age. In children between the ages of 12 and 24 months, the WHO recommends a reduced dose of 200 mg. Cure rates for light-to-moderate Ascaris infections typically are >97%, although heavy infections may require therapy for 2-3 days. A 400-mg dose of albendazole appears to be superior to a 500-mg dose of mebendazole for curing hookworm infections. 

Pyrantel pamoate is an alternative to mebendazole in the treatment of ascariasis and enterobiasis. High cure rates have been achieved after a single oral dose of 11 mg/kg (maximum of 1 g). Pyrantel also is effective against hookworm infections caused by A. duodenale and N. americanus, although repeated doses are needed to cure heavy infections with the latter organism. The drug is combined with oxantel for mixed infections with T. trichiura. For pinworm, treatment should be repeated after an interval of 2 weeks. In the U.S., pyrantel is sold over-the-counter for pinworm treatment (PiN-x). 

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