Anthelmintics

Question 1

Albendazole Usage

Answer 1

Porkworm, Cystic Hydatid disease (Liver, lungs, perineal), Dog Tapeworm

Question 2

Albendazole Dose

Answer 2

Patients weighing less than 60 kg: 15 mg/kg per day in 2 divided doses (max 800 mg per day)
Patients weighing 60 kg or more: 800 mg per day in 2 divided doses

Question 3

Albenddzole Pearls

Answer 3

Can cause severe bone marrow suppression, especially in hepatic impairment; discontinue if clinically significant decreases in complete blood count (CBC) occur
May elevate liver function tests (LFTs); discontinue if LFTs rise to more than 2 times the upper limit of normal
Take with high-fat meal for optimal bioavailability
When treating neurocysticercosis, use anticonvulsants and corticosteroids during first week
Monitor: fecal specimens for ova and parasites 3 weeks after treatment, LFTs, CBC with differential, and perform ophthalmic exam if treating neurocysticercosis to determine eye involvement

Question 4

Ivermectin Usage

Answer 4

Strongyloidiasis of intestinal tract (Strongyloides stercoralis [nematode])
Onchocerciasis (Onchocerca volvulus [immature nematode])
Head lice (Pediculus capitis)
Rosacea

Question 5

Ivermectin Dose

Answer 5

Usual oral dose for onchocerciasis:
150 mcg/kg single dose
Usual oral dose for strongyloidiasis:
200 mcg/kg single dose (alternatively, once daily for 2 days per CDC)
Topical lotion for head lice: Apply enough to cover dry scalp and hair for single use
Topical cream for rosacea: Apply to affected area daily

Question 6

Ivermectin Pearls

Answer 6

Systemic exposure can cause cutaneous and systemic reactions, especially in hyper-reactive onchodermatitis
Assess for loiasis if has traveled to West and Central Africa, and pretreat before systemic exposure (serious/fatal encephalopathy has been reported in patients with Loa loa infection)
Take oral on empty stomach with water for optimal bioavailability (bioavailability increased 2.5-fold when administered with a high-fat meal)
No activity against adult Onchocerca volvulus
Monitor (systemic): skin and eye microfilarial counts, ophthalmologic exams, stool exam post treatment
Leave lotion on for 10 minutes, then rinse out; recommend washing clothing, bedding, and hair accessories

Question 7

Praziquantel Usage

Answer 7

Schistosoma (blood flukes)
Clonorchis sinensis (liver fluke)
Opisthorchis viverrini (liver fluke

Question 8

Praziquantel Dosage

Answer 8

Usual oral dose for onchocerciasis:
150 mcg/kg single dose
Usual oral dose for strongyloidiasis:
200 mcg/kg single dose (alternatively, once daily for 2 days per CDC)
Topical lotion for head lice: Apply enough to cover dry scalp and hair for single use
Topical cream for rosacea: Apply to affected area daily

Question 9

Praziquantel Pearls

Answer 9

Use with caution in patients with cardiac abnormalities
Systemic exposure can increase in patients with moderate to severe hepatic impairment
Not recommended for use if patient has a history of seizures or infection involves the CNS
Swallow tablets quickly with water to avoid potent bitter taste
Caution patients about driving and operating machinery (adverse effects may last for 2 days)
Drug interactions may require dose adjustments
Patients with cerebral cysticercosis should be hospitalized during treatment
May not be effective in migrating schistosomiasis and can potentiate severe reactions caused by a sudden inflammatory immune response
Monitor: LFTs, seizures, patients with cardiac abnormalities, and a feces exam for ova prior to use

Question 10

Pyrantel Usage

Answer 10

Pinworms (Enterobius vermicularis)

Question 11

Pyrantel Dosage

Answer 11

Usual oral dose:

11 mg/kg single dose (max 1 g per dose)

Question 12

Pyrantel Pearls

Answer 12

Use with caution in patients with hepatic impairment owing to risk of increased exposure
Alternative agent; not first-line therapy
Treat family members who were in close contact with the patient
Monitor: feces for eggs, worms, and occult blood
Usual oral dose is based on pyrantel base