Worms

Summary of changes

Addition

  • Asymptomatic eosinophilia advice and treatment 
  • Repeat doses of pyrantel after 2 weeks for hookworm and threadworm
  • Repeat dose of praziquantel for dwarf tapeworm if heavy infection
  • People with weakened immune system may need 4 or more doses of ivermectin/extended treatment

Deletion

  • Strongyloides serology for eosinophilia 

Medicines

  • Albendazole advice - do not give to females who are in first trimester of pregnancy (previously do not give if pregnant) 
  • For hookworm and threadworm: repeat doses of pyrantel after 2 weeks
  • For dwarf tapeworm: repeat dose of praziquantel if heavy infection
  • For people with weakened immune system: may need 4 or more doses of ivermectin/extended treatment

Other

  • Remote context — This protocol focuses on aggressive management using 3 monthly ivermectin if immune compromised, as cannot rely on serology  which may be negative despite heavy infection. Hansen (2020) shows that people who are seropositive in communities have no increased illness and supports the included aggressive management to prevent serious complications of strongyloides
  • Comment from Specialist reviewer re advice on taking albendazone and ivermectin together (asymptomatic eosinophilia) with milk/fatty food: If giving single dose of ivermectin important to emphasise that it is taken with full cream milk/fatty food as it doubles bioavailability. But with albendazole you want with water on empty stomach for hookworm, whipworm as more stays in gut, but when using for internal parasites better with food as more is absorbed. So pragmatic here is OK if the albendazole is with food. In ideal world first dose albendazole at same time as ivermectin with food then days 2 and 3 with water on empty stomach!!

Primary references

  1. Barda B (2022) 'Ivermectin and albendazole against Trichuris trichiura: a long and winding road', The Lancet Infectious Diseases, 22(1):10-12, doi:10.1016/S1473-3099(21)00498-9

  2. Buonfrate D, Salas-Coronas J, Muñoz J, Maruri BT, Rodari P, Castelli F, Zammarchi L, Bianchi L, Gobbi F, Cabezas-Fernández T, Requena-Mendez A, Godbole G, Silva R, Romero M, Chiodini PL and Bisoffi Z (2019) 'Multiple-dose versus single-dose ivermectin for Strongyloides stercoralis infection (Strong Treat 1 to 4): a multicentre, open-label, phase 3, randomised controlled superiority trial', The Lancet Infectious Disease, 19(11):1181-1190, doi:10.1016/S1473-3099(19)30289-0

  3. Expert Groups for Antibiotic, version 16 (2021) Antibiotic, Therapeutic Guidelines, accessed 24 April 2022.

  4. Hansen M, Bowden E, Currie BJ, Ward L, Andrews RM, Dhurrkay RG, Gurruwiwi GG and Kearns T (2020) 'Strongyloides stercoralis seropositivity is not associated with increased symptoms in a remote Aboriginal community', Internal Medicine Journal, 51(8):1286-1291, doi:10.1111/imj.14884

  5. Hürlimann E, Keller L, Patel C, Welsche S, Hattendorf J, Ali SM, Ame SM, Sayasone S, Coulibaly JT and Keiser J (2022) 'Efficacy and safety of co-administered ivermectin and albendazole in school-aged children and adults infected with Trichuris trichiura in Côte d'Ivoire, Laos, and Pemba Island, Tanzania: a double-blind, parallel-group, phase 3, randomised controlled trial', The Lancet Infectious Diseases, 22(1):123-135, doi:10.1016/S1473-3099(21)00421-7

  6. Kimberley Aboriginal Medical Services and WA Country Health Services Kimberley (2020) Parasitic Worms, Kimberley Clinical Protocols, accessed 5 October 2022.

  7. The Royal Children's Hospital Melbourne (2013) Intestinal Parasites, Immigrant Health Service, accessed 5 October 2022.

  8. Walia B, Kmush BL, Lane SD, Endy T, Montresor A and Larsen DA (2021) 'Routine deworming during antenatal care decreases risk of neonatal mortality and low birthweight: A retrospective cohort of survey data', PLOS Neglected Tropical Disease, 15(4):e0009282, doi:10.1371/journal.pntd.0009282

  9. World Health Organization (2017) Preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups, World Health Organization, Geneva, accessed 5 October 2022.