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Chapter 149: Helminthic Infections

Austinn C. Miller; Susuana Adjei; Laurie A. Temiz; Stephen K. Tyring

HELMINTHIC INFECTIONS

Therapeutic Approach

Helminths are parasitic worms of medical importance, divided into 3 classes: nematodes (roundworms), trematodes (flukes), and cestodes (tapeworms). Endemic areas vary for many helminths; however, given the ease of travel, infections may be seen anywhere. A wide array of helminths causes cutaneous disease. Therapy should target the specific worm causing infection. When possible, the authors recommend using benzimidazoles given their superior efficacy and side-effect profile. See Table 149-1.

Table 149-1Helminths Treatment Table
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Table 149-1 Helminths Treatment Table
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MEDICATION NAME INDICATIONb MECHANISM OF ACTION DOSING ADVERSE EFFECTS SUGGESTED MONITORING LEVEL OF EVIDENCE (REFERENCE)
Topical Therapy      
Thiabendazole 15% ointment Localized CLM Anti-parasitic 2-3 times daily for 5-10 d Minor burning sensation Monitor for new tracks IIB1,2
Systemic Therapy      
Albendazole CLM Antiparasitic 400 mg PO daily for 3-5 d Avoid use in pregnancy when possible; headache, GI upset, agranulocytosis, leukopenia, anemia, thrombocytopenia, increased LFTs, seizures, angioedema, Mazzotti reaction (avoid use in those with high-grade microfilaremia)      Fecal specimens 3×/wk, CBC and LFTs at initiation and q2wk thereafter IB2,3
  Toxocariasis Antiparasitic 400 mg PO BID for 5 d IV4
  Gnathostomiasis Antiparasitic 400 mg PO BID for 21 d IIA5
  Enterobiasis Antiparasitic 400 mg PO once, repeat in 2 wk IIB6,7
  Filariasis (Wuchereria bancrofti) Antiparasitic Albendazole 400 mg PO once (with DEC or ivermectin) IB6,8
  Loiasis Antiparasitic 800 mg daily PO for 28 d (followed by ivermectin or DEC) III9
  Trichinellosis Antiparasitic 400 mg PO twice daily for 8-14 d (add steroids if severe) IV10
  aEchinococcosis Antiparasitic 10-15 mg/kg/d PO in 2 divided doses for 1-6 mo IA11
  Cysticercosis Antiparasitic 15 mg/kg/d PO in 2 doses for 8-30 d IA12
Mebendazole aEnterobiasis Antiparasitic 100 mg PO once, repeat in 2 wk Avoid use in pregnancy when possible; GI upset, agranulocytosis, neutropenia, increased LFTs, seizures, angioedema, Mazzotti reaction (avoid use in those with high-grade microfilaremia)    Periodic CBC, LFTs IB13
  Toxocariasis Antiparasitic 100-200 mg PO for 5 d IV4
  Mansonellosis Antiparasitic 200 mg PO daily for 28 d (more effective when used with DEC) IIA14
  Echinococcosis Antiparasitic 40–50mg/kg/d PO in 3 divided doses for 1-6 mo IA11,15
Praziqantel aSchistosomiasis Antiparasitic S. haematobium, S. intercalatum, or S. mansoni: 40 mg/kg/d PO once; S. japonicum or S. mekongi: 60 mg/kg/d PO once in 2 or 3 divided doses. Retreatment may be needed in 2-4 wk Avoid use in pregnancy when possible; dizziness, headache, malaise, urticarial, GI upset, fever, cardiac dysrhythmia, Mazzotti reaction (avoid use in those with high-grade microfilaremia) LFTs; monitor patients with cardiac irregularities during treatment; monitor for seizures; culture urine or feces for ova prior to instituting therapy IA16
  Paragonimiasis Antiparasitic

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