Hookworm infection treatment

Pyrantel Pamoate. This dmg (10), C24H2qN20 S, cures pinworm infections and is close to 100% effective against A.scaris when given in a single dose (28,29). Pyrantel pamoate is also a principal dmg for the treatment of hookworm infections thus it is useful in patients with mixed worm infections. 

Mebendazole is a benzimidazole carbamate derivative that is used for the treatment of threadworm, roundworm, whipworm and hookworm infections. It is not recommended for women who are pregnant and in children under 2 years because the manufacturer reports that toxicity in animal studies has been reported. 

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. 

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. 

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. 

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. 

Bitoscanate (phenylene 1,4-diisothiocyanate) enjoyed some clinical interest in the treatment of hookworm infection in around 1975 (1), but it proved highly dangerous, and deaths have occurred with as little as 300 mg. Most of the publicity that it has had in recent years relates to its listing as an extremely hazardous substance, and the US Office of Homeland Security has actually regarded it as a possible tool for bioterrorism. 

The inhalation of thymol, in combination with other volatile substances, is used to alleviate the symptoms of colds, coughs, and associated respiratory disorders. Externally, thymol has been used in dusting powders for the treatment of fungal skin infections. Thymol was formerly used in the treatment of hookworm infections but has now been superseded by less toxic substances. 

This is an effective drug for the treatment of hookworm infections in humans. The drug possesses better activity against A. duodenale than against N. americanus. The drug is administered orally at a dose of 5 g (2.5g base)/adult and 2.5g (1.25g base)/child [12,23,34,89]. Bephenium hydroxynaphthoate has been used in individual and community treatment of ancylostomiasis with high success however, it was not possible to eradicate the infection completely [90-92]. 

The first monoterpene found to have anthelmintic activity was ascaridole (6) which, alone or as a component of plant extracts, has been used in the treatment of hookworm infection [37]. Ascaridole is also a potent in vitro inhibitor (LC 0.05 jiM) of the development of the malarial parasite Plasmodium falciparum [173]. Thymol also exhibits anthelmintic activity, but is too toxic to be considered for use in animals and humans [37]. Since many monoterpenes taken internally in high doses are known to cause problems (irritation, acute toxicity) [174], more attention has been paid to evaluating these compounds against phytoparasitic nematodes. 

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). 

It is widely used across the globe for the management and treatment of intestinal nematode infection. It is also quite effective as a single-dose-treatment for ascariasis, New and Old World hookworm infections, and trichuriasis. It has been observed that a recommended multi-dose therapy with albendazol may help in the complete eradication of pinworm, threadworm, capillariasis, chlonorchiasis, and hydated disease as well. However, the overall observed effectiveness of albendazole against tapeworms (cestodes) is obviously more variable and less impressive apparently. 

Thiabendazole (Mintezo ) (XXVIII) and bephenium hydroxynaphthoate (Alcopar ) (XXIX) are now available in the United States for the treatment of intestinal parasitoses. Thiabendazole is claimed to be particularly effective against enterobiasis and strongyloidiasis (threadworm disease). Bephenium is reported to be effective against hookworm infections. 7... 

Stwngyloides stercoralis infection is acquired, like hookworm, from filariform larvae in contaminated soil that penetrate the skin. This parasite maintains itself for many decades in the small intestine asymptomatically. Persons treated with immunosuppressive drugs or who are debilitated by chronic illness may be at risk for widespread tissue invasion or hyperinfection syndrome. Prompt treatment may be life saving in disseminated disease. 

Pyrantel pamoate is a broad-spectrum antihelminthic highly effective for the treatment of pinworm, ascaris, and Trichostrongylus orientalis infections. It is moderately effective against both species of hookworm. It is not effective in trichuriasis or strongyloidiasis. Oxantel pamoate, an analog of pyrantel not available in the USA, has been used successfully in the treatment of trichuriasis the two drugs have been combined for their broad-spectrum antihelminthic activity. 

Albendazole (Albenza) is primarily used to treat infections caused by the larval form of certain cestodes (tapeworms). These infections often cause cysts (hydatid disease) in the liver, lungs, and other tissues albendazole is used as an adjunct to the surgical removal of these cysts or as the primary treatment if these cysts are inoperable. This drug is also effective against many gastrointestinal roundworms and hookworms, and is typically used as a secondary agent if other anthelmintics are not effective in treating these infections. 

Pyrantel pamoate [pi RAN tel] along with mebendazole is effective in the treatment of infections caused by roundworms, pinworms (see Figure 36.4), and hookworms. Pyrantel pamoate is poorly absorbed orally and exerts its effects in the intestinal tract. It acts as a depolarizing neuromuscular blocking agent, causing persistent... 

Sorensen S, Melgaard B. Treatment of hookworm anemia. Scand J Infect Dis 1971 3(l) 65-9. 

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