50
B. HELMINTHS
(1)Filariasis (The Medical Letter, 1189:1–12, 2004)
(a)Onchocerciasis (Onchocerca volvulus), ‘‘river blindness’’
Drug |
Trade |
Dose |
|
|
150 mg/kg 1, repeated |
ivermectin |
Mectizan |
|
|
|
every 6–12 months |
|
|
until asymptomatic |
|
|
|
Notes: 1) Consider antihistamines or corticosteroids to reduce allergic reaction caused by dead microfilaria
2)Pediatric dosing is the same
(b)Loasis (loa loa)
Drug |
Trade |
Dose |
Notes |
diethylcarbamazine |
Hetrazan |
6 mg/kg in 3 doses 14 days |
Pediatric Dose the same |
|
|
|
|
Notes: 1) Heavy filaria burden may induce encephalopathy; may use ivermectin or albendazole or apheresis to reduce microfilarial counts (Infect Dis Clin North Am, 7:619, 1993).
2) Consider antihistamines or corticosteroids to reduce allergic reaction caused by dead microfilaria (‘‘Mazzotti reaction’’)
(2) Tapeworm (Taenia solium), ‘‘Cysticercosis’’
Notes: 1) Anti-helminth treatment is usually not indicated for isolated conjunctival or retinal disease, but is indicated for orbital involvement.
2)Consider obtaining CT scan to rule out neurocystercercosis, especially if anti-helminth medications are going to be used since inflammation secondary to death of organism can be fatal.
3)Isolated conjunctival involvement may be treated with surgical excision alone.
4)For posterior segment involvement, laser of worm or vitrectomy to remove organism may be preferable.
5)Anti-helminth medical regimens for orbital involvement are not standardized, but some regimens are described. Combination of albendazole or praziquantel in conjunction with prednisone (to decrease inflammation) for four weeks has been recommended (Ophthalmology 104; vol 10 p. 1599–1604. 1997), although single dose praziquantel has also been described (The Medical Letter, 1189:1–12, 2004).
albendazole |
Zentel |
15 mg/kg/day PO 4 weeks |
Ophthalmol. 104;(10) 1599–1604. 1997) |
|
|
|
Pediatric dosing same. |
praziquantel |
Biltricide |
5–10 mg/kg once |
The Medical Letter, 1189:1–12, 2004 |
|
|
1.5–2.0 mg/kg/day 4 weeks |
Pediatric dosing same |
prednisone |
|
|
|
|
|
|
|
Anti-Parasitic Agents 51
52
(3) Toxocariasis Visceral Larva Migrans (T. canis)
Drug |
Trade |
Dose |
Notes |
albendazole |
Zentel |
400 mg PO BID 3–5 days |
Pediatric dosing same |
thiabendazole |
|
25 mg/kg PO BID 3–5 days |
Pediatric dosing same |
Note: Treatment with albendazole may cause an intense inflammatory reaction as the worm dies and require concurrent steroid use.