Treatment of Strongyloides stercoralis infection with ivermectin compared with albendazole: results of an open study of 60 cases

Abstract

Ivermectin is highly effective against animal intestinal nematodes and is used in the treatment of onchocerciasis in humans. A study was undertaken to compare the efficacy of the drug with that of albendazole in the treatment of uncomplicated strongyloidiasis. Sixty patients with confirmed Strongyloides stercoralis infection were enrolled in an open randomized study and given either albendazole, 400 mg/d for 3 d or ivermectin, 150-200 micrograms/kg in a single dose. Efficacy and tolerance were evaluated on days 7, 30 and 90. Each visit included a parasitological examination of 3 stool specimens, using saline and Kato smears and formalin-ether and Baermann concentrations. Fifty-three patients were eligible for evaluation. Parasitological cure was obtained in 24 of the 29 patients treated with ivermectin (83%) and in 9 of the 24 patients who were given albendazole (38%); ivermectin was significantly more effective than albendazole (P < 0.01). Clinical and biological adverse reactions were negligible in both treatment groups. The 20 patients who failed therapy were given a second treatment course with 150-200 micrograms/kg of ivermectin in a single dose or on 2 consecutive days. Sixteen patients were cured and the other 4 had only incomplete follow-up. Ivermectin therefore constitutes an acceptable therapeutic alternative for uncomplicated strongyloidiasis.

57-Year-Old Man With Fever, Rash, Chronic Watery Diarrhea, Cough, and Sweats

“…Oral albendazole at a dosage of 400 mg twice a day for 7 days is another alternative but has lower efficacy. 7,9 In severe strongyloidiasis, combination therapy with albendazole and ivermectin has also been reported. 15 Case reports have described the use of veterinary parenteral and enema formulations of ivermectin on a compassionate basis following institutional review board approval in patients with severe hyperinfection who are unable to tolerate oral therapy.…”

“…11,14 Treatment response can be monitored with absolute eosinophil count, which is expected to improve within 3 months after treatment. 9 Serologic monitoring may be helpful; antibody levels are expected to markedly decrease within 6 months after treatment. 11 Persons involved in international travel, especially to endemic regions, should be informed about the risk of S stercoralis infection and be advised on proper hygiene, including the use of protective footwear and avoidance of drinking from contaminated water bodies.…”

“…The absolute eosinophil count decreases markedly within 3 to 6 months after successful therapy. 9,10 The patient was examined at our clinic 6 weeks after treatment with ivermectin. A repeat complete blood cell count with differential revealed a decrease of the eosinophil count from 36% (measured at the patient's initial examination at our institution) to 13%.…”

Tratamiento de Strongyloides stercoralis con ivermectina y tiabendazole

“…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.…”

“…Es importante describir periódicamente la experiencia que existe en nuestro país con estos medicamentos, ya que los demás fármacos antiparasitarios utilizados comúnmente en nuestro país no ofrecen toda la eficacia y seguridad deseadas para estos casos ( 1,13,17 ). Este trabajo describe los resultados en nuestra institución, para así promover el ingreso de ambos medicamentos al mercado nacional y enfrentar mejor esta infección.…”