From the Guidelines
The treatment for cutaneous larva migrans (CLM) is with ivermectin (200 mg/kg as a single dose) or albendazole (400 mg od for 3 days). For the treatment of CLM, the following options are available:
- Ivermectin: a single dose of 200 mg/kg, which is the preferred treatment due to its efficacy and convenience, as noted in the study published in the Journal of Infection 1
- Albendazole: 400 mg daily for 3 days, which is an alternative treatment option, also mentioned in the same study 1 Additional considerations:
- Symptomatic relief can be achieved with antihistamines for itching
- Keeping the affected area clean and dry to prevent secondary bacterial infections is crucial It is essential to note that the treatment aims to prevent further migration of larvae, reduce symptoms, and avoid potential complications such as secondary bacterial infections. The choice between ivermectin and albendazole should be based on the individual patient's condition, potential contraindications, and the severity of the infection. In general, ivermectin is considered the first-line treatment due to its high efficacy and safety profile, as supported by the study published in 2010 1.
From the FDA Drug Label
Ivermectin is active against various life-cycle stages of many but not all nematodes. The treatment for cutaneous larva migrans (CLM) is not directly mentioned in the provided drug label. No conclusion can be drawn about the treatment of CLM with ivermectin based on this information 2.
From the Research
Treatment Options for Cutaneous Larva Migrans (CLM)
- The preferred first-line treatment for CLM is oral ivermectin, which has been shown to be effective in several studies 3, 4, 5, 6.
- Topical therapy is also an option, particularly for cases where the skin is only affected, with topical thiabendazole being a recommended treatment 4.
- Other treatment options include albendazole, which has been shown to be effective in some studies, but may have a lower cure rate compared to ivermectin 5, 6.
- Topical ivermectin has also been reported to be effective in some cases, with the advantage of fewer adverse effects compared to oral ivermectin 7.
- Freezing the leading edge of the skin track with liquid nitrogen is not a recommended treatment option, as it is rarely effective and may cause side effects 4, 6.
Comparison of Treatment Efficacy
- A study comparing the efficacy of ivermectin and albendazole found that ivermectin had a cure rate of 100%, while albendazole had a cure rate of 46% 5.
- Another study found that a single 12-mg dose of ivermectin had a cure rate of 81-100%, while a single 400-mg dose of albendazole had a cure rate of 46-100% 6.
Treatment Recommendations
- Oral ivermectin is recommended as the first-line treatment for CLM due to its high efficacy and relatively low risk of adverse effects 3, 5, 6.
- Topical therapy, such as topical thiabendazole or ivermectin, may be considered for cases where the skin is only affected or where oral ivermectin is not available or tolerated 4, 7.