18b Treatment for Parasitic Infection (Worms) Goad

Question 1

What are the signs and symptoms of Enterobius vermicularis?

Answer 1

Pinworm. Abdominal pain, Grinding teeth, Insomnia, Irritability, Nocturnal perianal itching. Highly contagious

Question 2

What drugs are used to treat Pinworm?

Answer 2

Mebendazole (Vermox) - DOC. Pyrantel pamoate (OTC)

Question 3

What are the general characteristics of Mebendazole (Vermox)?

Answer 3

DOC for Enterobius vermicularis. Broad spectrum antihelminthic. Cidal against adult/larval Ascaris, pinworm, hookworm. Pregnancy Category C

Question 4

How is Mebendazole (Vermox) dosed for pinworm?

Answer 4

100mg chewable tabs (no liquid). Take with fatty meal to increase BA. Single dose therapy patient and family

Question 5

What are the ADRs associated with Mebendazole?

Answer 5

Rare: Abdominal cramping

Question 6

How is Pyrantel Pamoate dosed for pinworm?

Answer 6

Single dose therapy patient and family, evaluate at 2 weeks for 2nd dose need. 11mg/kg; max 1gm dose. Liquid (50mg/ml) and soft gels. See pediatrician if < 2 years. Pregnancy category C

Question 7

What are the ADRs associated with Pyrantel Pamoate?

Answer 7

HA, N/V, abdominal cramps

Question 8

How do you acquire Taeniasis and Cysticercosis?

Answer 8

Eating raw or undercooked meat

Question 9

What is Taeniasis?

Answer 9

Tape worm infection. Taenia saginata (beef tapeworm), solium (pork tapeworm), asiatica (Asian tapeworm)

Question 10

What is Cysticercosis?

Answer 10

Trop penetrates gut, lodges in muscles or brain

Question 11

What is the Taeniasis and Cysticercosis treatment?

Answer 11

Kill living worms and cysticerci (Albendazole or Praziquantel). Antihelminthic therapy NOT indicated for calcified cysts (dead worms)

Question 12

What are the general characteristics of Albendazole?

Answer 12

Active against larval/adult nematodes (ovacidal against Ascaris). Fatty meal increase levels 2-4 fold. Single dose treatment has few ADRs. Better tolerated than mebendazole and thiabendazole

Question 13

What are the general characteristics of Praziquantel (Biltricide)?

Answer 13

Kills adult worms. PO 1-3x a day x1 day (depending on infection treated)

Question 14

What are the ADRs associated with Praziquantel?

Answer 14

Cardiac arrhythmias, seizure

Question 15

What is Schistosomiasis?

Answer 15

Trematode (blood fluke): Schistosoma mansoni, japonicum, haematobium. “Swimmers itch”. High fever, malaise, cough, diarrhea, and hives

Question 16

What is treatment for Schistosomiasis?

Answer 16

Treat with Praziquantel (1 tab BID x1 day)

Question 17

What is the cycle for Schistosomiasis?

Answer 17

Defecation near river, egg hatches in water –> Miracidium penetrates snail host –> cercaria released into water where it infects human host

Question 18

What is Filariasis?

Answer 18

Biting insects transmit worm larvae. Not diseases of travelers. Lymphatic filariasis (Wuchereria bancrofti: elephantiasis: from mosquito). Onchocerciasis (Onchocerca volvulus: river blindness: from black flies). Loiasis (Loa loa: eye worm: from deer flies)