Cutaneous larva migrans, treatment

Several benzimidazoles are in use for the treatment of helminthic infections. Three of these, mebendazole, thiabendazole and albendazole, are described in this section. They have a broad range of activity against many nematode and cestode parasites, including cutaneous larva migrans, trichinosis, disseminated strongyloidiasis, and visceral larva migrans. A fourth, triclabendazole, is considered as the drug of choice for Easciola hepatica therapy. 

The answer is c. (Hardman, p 1688.) Thiabendazole has been shown to be effective against Strongyloides, cutaneous larva migrans, and Trichuris. Adverse effects consist of nausea, vertigo, headache, and weakness. Treatment usually involves oral administration for several days. It has been found to be ineffective in Ascaris, N. americanus, E. vermicularis, and T. saginata. 

Thiabendazole is an alternative to ivermectin or albendazole for the treatment of strongyloidiasis and cutaneous larva migrans. 

The standard dosage, 25 mg/kg (maximum 1.5 g) twice daily, should be given after meals. Tablets should be chewed. For strongyloides infection, treatment is for 2 days. Cure rates are reportedly 93%. A course can be repeated in 1 week if indicated. In patients with hyperinfection syndrome, the standard dose is continued twice daily for 5-7 days. For cutaneous larva migrans, thiabendazole cream can be applied topically, or the oral drug can be given for 2 days (although albendazole is less toxic and therefore preferred). 

Gourgiotou K, Nicolaidou E, Panagiotopoulos A, Hatziolou JE, Katsambast AD. Treatment of widespread cutaneous larva migrans with thiabendazole. J Eur Acad Dermatol Venereol 2001 15(6) 578-80. 

In 80 children aged 6 months to 14 years a single dose of ivermectin 200 micrograms/kg was compared with topical benzyl benzoate for the treatment of pediatric scabies in a randomized, controlled trial (17). Ivermectin cured 24 of 43 patients and topical benzyl benzoate cured 19 of 37 patients at 3 weeks after treatment. There were no serious adverse effects with either treatment, although benzyl benzoate was more likely to produce local skin reactions. These results are in line with those of another study, in which 18 children aged 14 months to 17 years with either scabies (n — 11) or cutaneous larva migrans (n — 7) were... 

Thiabendazole, an anthelmintic (22 mg/kg t.i.d. after meals), is indicated for the treatment of strongyloidiasis (threadworm infection), cutaneous larva migrans (creeping eruption), and visceral larva migrans. 

Taken as a single 200- ig/kg oral dose, ivermectin is a first-line drug for treatment of cutaneous larva migrans. Similar doses also are safe and highly effective against human head lice and scabies, even in HIV-infected individuals. 

Tissue nematodes responsive to drug therapy include ancyclostoma species, which cause cutaneous larva migrans, seen primarily in the southern USA. Species of dracunculus, onchocerca, toxo-cara, and Wuchereria bancrufti (the cause of filariasis) are all responsive to drug treatment. The number of persons worldwide estimated to be infected by tissue nematodes exceeds 0.5 billion. 

Clinical use Thiabendazole is a drug of choice for visceral forms of larva migrans and is an effective drug for treatment of strongyloidiasis, cutaneous larva migrans, and threadworm infections. Thiabendazole is rapidly absorbed from the gut and is metabolized by liver enzymes. The drug has anti-inflammatory and immunorestorative actions in the host. 

Another case of alopecia in the form of telogen effluvium was reported in a 27-year-old female patient in her second week of a 2-week course of daily albendazole 400 mg for treatment of cutaneous larva migrans. Remission was noted in 3 months will full restoration of normal hair observed at 11 months [ll ]. 

---