A Randomized Trial of Single- and Two-Dose Ivermectin versus Thiabendazole for Treatment of Strongyloidiasis

Abstract

A randomized trial is described comparing ivermectin and thiabendazole for treatment of chronic infection with Strongyloides stercoralis. Subjects received ivermectin (200 micrograms/kg) in a single dose, ivermectin (200 micrograms/kg) on 2 consecutive days, or thiabendazole (50 mg/kg/day) twice daily for 3 consecutive days. Most subjects (94%) had intermittent symptoms, including urticaria, epigastric pain, and diarrhea. Stools were examined 7 days and 1, 3, 6, 10, and 22 months after treatment. Fifty-three subjects completed at least 3 months of follow-up. Only 1 of 34 and 2 of 19 ivermectin and thiabendazole subjects, respectively, had a stool positive for larvae after treatment. Symptoms were relieved in all 3 groups and eosinophil levels returned to normal in 90% of all subjects by 12 months. Nearly 95% of thiabendazole subjects had short-term adverse effects during therapy versus only 18% of those treated with ivermectin. One dose of ivermectin provides safety and efficacy equivalent to thiabendazole with a much lower prevalence of side effects and, consequently, better compliance.

Serology and eosinophil count in the diagnosis and management of strongyloidiasis in a non-endemic area.

“…28,29 More recently, albendazole and ivermectin have been shown to be more efficacious and better tolerated than thiabendazole for the treatment of strongyloidiasis. [30][31][32] However, one of the most difficult problems associated with the management of Strongyloides infection has been the inability to ensure the parasite has been successfully eliminated following treatment.…”

Tratamiento de Strongyloides stercoralis con ivermectina y tiabendazole

“…Los resultados de la experiencia del uso de estos fármacos concuerdan con los reportes internacionales de eficacia de ambas drogas ( 8,13,17,18,[20][21][22][23][24][25] ), la cual se mantiene a menos que existan otros problemas de salud concomitantes ( 30-33 ); así como también la seguridad que representan, especialmente tiabendazole, que según varios reportes es causante de reacciones adversas indeseables ( 27-29 ); ninguna de ellas se presentó en el grupo estudiado. En el caso de ivermectina, es sabido que es una droga muy segura con casi nula presentación de efectos indeseables ( [17][18][19][20][21] ).…”

“…En el caso de ivermectina, es sabido que es una droga muy segura con casi nula presentación de efectos indeseables ( [17][18][19][20][21] ).…”

“…Es conocido que existen dos drogas altamente eficaces contra este parásito, ivermectina ( 13,(17)(18)(19)(20)(21) ) y tiabendazole ( [22][23][24][25][26] ), lo que las convierte en drogas de primera elección para el manejo de estos casos. Sin embargo, por razones no bien explicadas, ivermectina no circula en el mercado farmacéutico nacional y tiabendazole existe pero en forma restringida, sin ser accesible a la población que padece el problema.…”

Skin test antigens for immediate hypersensitivity prepared from infective larvae of Strongyloides stercoralis.

“…None had acute signs or symptoms of strongyloidiasis, but a history of intermittent epigastric pain, episodic diarrhea, and recurrent urticaria over the lower abdomen, thighs, and buttocks could often be elicited. 13 Most of the patients also had elevated peripheral blood eosinophilia.…”