From the Guidelines
The treatment for a patient with a parasite in their stool should be guided by the specific parasite identified, with praziquantel being a key treatment option for certain parasites such as Schistosoma species, at a dose of 40 mg/kg as a single dose for S. mansoni, S. intercalatum, and S. guineensis infections, and 60 mg/kg in two divided doses for S. japonicum and S. mekongi infections, as recommended by the most recent guidelines 1.
Key Considerations
- The choice of treatment depends on accurately identifying the parasite, which may involve serology, microscopy of concentrated stool samples, or other diagnostic methods.
- For Schistosomiasis, praziquantel is the recommended treatment, with the dose and administration schedule varying depending on the specific species of Schistosoma involved, as outlined in the guidelines 1.
- It's crucial to follow the recommended treatment regimen and to ensure the patient completes the full course of medication, even if symptoms improve before finishing, to prevent reinfection and transmission to others.
- Proper hygiene practices, including thorough handwashing, avoiding contaminated food and water, and proper food preparation, are essential in preventing the spread of parasitic infections.
Treatment Options
- For other parasites, such as Giardia, metronidazole or albendazole may be prescribed, with the specific dose and duration of treatment depending on the parasite and the patient's condition, as discussed in various guidelines and studies 1.
- The effectiveness of treatment should be confirmed with follow-up stool examinations 2-4 weeks after completing therapy to ensure the parasite has been successfully eliminated.
Important Notes
- The treatment approach may need to be adjusted based on factors such as the patient's immune status, the presence of any complications, and the specific characteristics of the parasite involved.
- Consulting with a specialist parasitology center may be necessary for complex or unusual cases, as recommended in the guidelines for the investigation and management of eosinophilia in returning travelers and migrants 1.
From the FDA Drug Label
Ivermectin is active against various life-cycle stages of many but not all nematodes. The evaluation of STROMECTOL in the treatment of onchocerciasis is based on the results of clinical studies involving 1278 patients Efficacy, as measured by cure rate, was defined as the absence of larvae in at least two follow-up stool examinations 3 to 4 weeks post-therapy.
The treatment for a patient with a parasite in their stool is ivermectin (PO), with a single dose of 170 to 200 mcg/kg, which has been shown to be effective in treating strongyloidiasis, with a cure rate of 92% in one study 2.
- Key points:
- Ivermectin is active against the intestinal stages of Strongyloides stercoralis
- At least three stool examinations should be conducted over the three months following treatment to ensure eradication
- If recrudescence of larvae is observed, retreatment with ivermectin is indicated
- Important consideration: Concentration techniques, such as using a Baermann apparatus, should be employed when performing these stool examinations, as the number of Strongyloides larvae per gram of feces may be very low 2.
From the Research
Treatment for Parasites in Stool
The treatment for a patient with a parasite in their stool depends on the type of parasite. Some common parasites and their treatments are:
- Enterobius vermicularis (pinworm): mebendazole and household sanitation 3
- Giardia lamblia: metronidazole, with preventive measures including sewage treatment, proper handwashing, and consumption of bottled water 3, 4, 5
- Ancylostoma duodenale and Necator americanus (hookworms): albendazole, mebendazole, pyrantel pamoate, iron supplementation, and blood transfusion 3, 6
- Entamoeba histolytica: luminal and tissue amebicides, including metronidazole, chloroquine, and aspiration for liver abscess 3
Treatment Options
Some studies have compared the effectiveness of different treatment options:
- Albendazole and mebendazole have been shown to be effective against a range of parasites, including intestinal nematodes and tissue nematodes/cestodes 6
- A study comparing albendazole and metronidazole for the treatment of giardiasis found that albendazole may be of similar effectiveness to metronidazole, with fewer side effects 4
- Combination treatment with a 5-nitroimidazole and a benzimidazole may be more effective than monotherapy for refractory giardiasis 5
Special Considerations
In patients with HIV infection or pulmonary tuberculosis, antiparasitic treatment may need to be tailored to the individual's specific needs:
- A study evaluating the efficacy of antiparasitic drugs in patients with HIV infection and pulmonary tuberculosis found that albendazole, mebendazole, and metronidazole were effective in treating concurrent parasitic diseases 7