Efficacy and safety of ivermectin and thiabendazole in the treatment of strongyloidiasis

Abstract

Treatment of strongyloidiasis has been traditionally based on thiabendazole, despite its frequent gastrointestinal side effects and failure to achieve eradication of the parasite from faeces in approximately 30% of cases. Ivermectin has been shown to be more effective for treating chronic uncomplicated strongyloidiasis. The efficacy and tolerability of these drugs in a series of patients treated from 1999 to 2002 at the Oliva Health Centre, Valencia, Spain, are reported. A total of 88 patients diagnosed of strongyloidiasis were treated using the following regimens: thiabendazole 25 mg/kg/12 h for 3 consecutive days in 31 patients; ivermectin 200 mug/kg as a single dose in 22 patients; and ivermectin 200 mug/kg for 2 consecutive days in 35 patients. The efficacy and side effects were recorded. A total of 65 patients were male, and 23 female. The mean age was 64 +/- 12 years. Of the patients, 44 had worked barefoot in rice fields. Among the 31 patients treated with thiabendazole, 25 (78%) met the criteria for cure (the absence of parasite in faeces after examination of three samples collected on alternate days), and 5 (16%) experienced side effects (asthenia, epigastralgia and disorientation). Of the 22 patients treated with ivermectin on a single day, 17 (77%) met the criteria for cure, and 2 (9%) reported side effects (dizziness, dyspepsia). Among the 35 patients treated with ivermectin on 2 consecutive days, 100% met the criteria for cure, and 0% experienced side effects. In chronic uncomplicated strongyloidiasis, a treatment regimen consisting of ivermectin 200 mug/kg for 2 consecutive days provided the best results with regard to efficacy and tolerability. When the eosinophilia continued after treatment, we observed a high percentage of not-cure rate (7 of 9 patients, 77%).

High Rate of Strongyloidosis Infection, Out of Endemic Area, in Patients with Eosinophilia and without Risk of Exogenous Reinfections

“…This outcome was unexpected as the drug of choice against S. stercoralis is the ivermectin whose cure rates reach 100% as referred by different studies. 4,27,28 Nevertheless, some authors reported values as low as 67%. 29 Uncomplicated infection may be treated with ivermectin 200 μg/kg of body weight single dose, although some reports suggested that two doses of ivermectin on consecutive days provided the best results with regard to efficacy.…”

“…29 Uncomplicated infection may be treated with ivermectin 200 μg/kg of body weight single dose, although some reports suggested that two doses of ivermectin on consecutive days provided the best results with regard to efficacy. 4,19,27,28 However, to certainly evaluate the results of treatment of S. stercoralis , stool examinations should be performed for at least 1 or 2 years when possible. 27 Even when cure cannot be assured, parasite burden drastically decreased below the threshold of detection after the parasiticide treatment.…”

Strongyloidiasis: A case with acute pancreatitis and a literature review

“…Single dose of Ivermectin (200 microgram per kilogram of bodyweight) orally was also shown to have superior cure rate of 97% vs 63% with high dose Albendazole 800mg orally daily for seven days [41] . Currently, oral Ivermectin in the dose of 200 microgram per kilogram of bodyweight repeated on two consecutive days or after 2 wk is the preferred drug for treatment of Strongyloides stercoralis (Table 4) [48,49] . In patients who cannot tolerate it orally, alternate routes like subcutaneous administration of Ivermectin has been advised [50] .…”

Strongyloides stercoralis infection in the immunocompromised host

“…Because even one remaining adult female can multiply and cause disseminated disease, the goal of treatment is complete eradication of the parasite. The current treatment of choice for chronic strongyloidiasis is single-dose ivermectin (Table 2), although some studies have suggested that two doses of ivermectin, 200 μg/kg, given on consecutive days may have greater efficacy [41]. Ivermectin has better tolerability compared with thiabendazole [42].…”