Ivermectin strongyloidiasis

The drug of choice for nematode infestations (hookworm, enterobiasis, and ascariasis) is mebendazole, while ivermectin is indicated for strongyloidiasis and praziquantel is indicated for tapeworms. 

The drug of choice for strongyloidiasis is oral ivermectin 200 mcg/kg per day for 2 days, while albendazole 400 mg twice... 

Ivermectin (9.119), a semisynthetic macrocyclic lactone, is the dmg of choice for strongyloidiasis and onchocerciasis types of helminth infestation. Ivermectin appears to paralyze the nematode, which may lead to its death but which certainly facilitates its expulsion from the body. 

Ivermectin is the drug of choice in strongyloidiasis and onchocerciasis. It is also an alternative drug for a number of other helminthic infections. 

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

Note Ivermectin is approved for use in the USA for the treatment of onchocerciasis and strongyloidiasis. See Chapter 65 for comment on the unlabeled use of drugs. 

The efficacy and adverse effects of ivermectin 200 micro-grams/kg, repeated 2 weeks later, have been stndied in 50 patients with chronic strongyloidiasis, aged 30-79 years (13). The eradication rate was 96% at 2 weeks after the first dose and 98% after the second dose. There was no recurrence after follow-up of 4 months. One patient had nausea and vomiting 3 hours after the first dose and again after the second dose, but they were transient and required no therapy. In four patients there were mild laboratory abnormalities (slight increases in liver function tests in two, microscopic hematuria in one, and mild leukopenia and lymphocytosis in one). Of the 50 patients 12 were positive for human T lymphotropic virus type-I. 

Zaha O, Hirata T, Kinjo F, Saito A, Fukuhara H. Efficacy of ivermectin for chronic strongyloidiasis two single doses given 2 weeks apart. J Infect Chemother 2002 8(l) 94-8. 

In view of these and previous cases of severe cholestasis after tiabendazole and the availability of less toxic equally effective drugs (albendazole or preferably ivermectin), tiabendazole must be considered obsolete in the treatment of strongyloidiasis. 

Igual-Adell R, Oltra-Alcaraz C, Soler-Company E, Sanchez-Sanchez P, Matogo-Oyana J, Rodriguez-Calabuig D. Efficacy and safety of ivermectin and thiabendazole in the treatment of strongyloidiasis. Expert Opin Pharmacother 2004 5(12) 2615-19. 

Analogous to the derivation of Synercid from a veterinary antibiotic, another famous example of the use of a modified veterinary product in man as an antiparasitic is the oral use of ivermectin (Mectizan, Stromectol) (42a (80%), 42b (20%) Figure 9) in the treatment of strongyloidiasis, onchocerciasis (river blindness), and for the treatment of filariasis. In addition to these uses (predominately in Africa), in 2006 Banyu received approval of the product in Japan for the treatment of scabies. ... 

The efficacy of ivermectin for human onchocerciasis was established in the 1980s and is summarized in this chapter briefly. Clinical study of ivermectin in human strongyloidiasis has not yet been completed. Here we describe the efficacy of ivermectin for human strongyloidiasis as observed in our institution during the past decade. Furthermore, we would like to describe the combination therapy with ivermectin and albendazole for bancroftian filariasis and also the efficacy of ivermectin in the treatment of human scabies. 

Adverse reactions accompanying the first administration of ivermectin occurred in nine patients (7.2%), and included dizziness (2.4%), nausea (1.6%), and diarrhea (1.6%). Each of these adverse reactions was mild and transient and none required particular treatment. After the second administration, adverse reactions occurred in five patients (4.0%), but this frequency was lower and adverse reactions were mild and transient. Mazzotti-type reactions associated with the treatment of onchocerciasis did not occur in these patients with strongyloidiasis treated with ivermectin (Table VI). 

Ivermectin is indicated for intestinal strongyloidiasis in France (1987) and the USA (1996). With a view to obtaining approval for treatment with ivermectin, we are proceeding with a clinical trial at 200 pg/kg. With administration by this method, a high rate of eradication and safety are being confirmed. Ivermectin is as effective as, and better tolerated than, thiabendazole for treating strongyloidiasis. 

Shikiya, K., Zaha, O., Niimura, S., Nakamura, H., Nakayoshi, T., Kochi, A., Uehara, X., Uechi, H., Ohshiro, J., Kinjo, E, and Saito, A. (1992). Clinical study of eradicated and resistant patients to treatment with ivermectin for strongyloidiasis. Kansenshogaku Zasshi. 66,935-943. 

Clinical use Ivermectin is the drag of choice for onchocerciasis, acts more slowly than diethylcarbamazine, and causes fewer systemic and ocular reactions. Ivermectin is also the drag of first choice for strongyloidiasis and an alternative agent in filariasis. 

---