What is the medication of choice to treat parasitic infections?

From the Guidelines

The medication of choice to treat parasitic infections depends on the specific parasite involved, with albendazole being a commonly used treatment for intestinal worms, and metronidazole or tinidazole for protozoan parasites like Giardia, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1.

Key Considerations

• The choice of medication depends on the type of parasite, with different medications being effective against different species.
• Proper diagnosis through stool examination, blood tests, or other appropriate methods is essential to identify the specific parasite and guide treatment.
• Treatment effectiveness should be confirmed with follow-up testing, especially for persistent infections.

Treatment Options

• For intestinal worms, albendazole (400mg as a single dose for most infections) or mebendazole (100mg twice daily for 3 days) are commonly used, as supported by the 2018 clinical practice guidelines for the diagnosis and treatment of neurocysticercosis 1.
• For protozoan parasites like Giardia, metronidazole (250-750mg three times daily for 5-10 days) or tinidazole are typically prescribed, with tinidazole being approved in the United States for children aged ≥3 years 1.
• For other parasitic infections, such as leishmaniasis, the choice of medication depends on the specific species and geographic region, with options including pentavalent antimonials, miltefosine, and amphotericin B, as discussed in the 2016 clinical practice guidelines for the diagnosis and treatment of leishmaniasis 1.

Important Considerations

• Side effects vary by medication but may include gastrointestinal disturbances, headache, or dizziness.
• Treatment should be individualized based on the specific parasite, patient factors, and potential for adverse events.
• The effectiveness of treatment should be monitored, and alternative treatments considered if necessary, as recommended by the clinical practice guidelines 1.

From the FDA Drug Label

14 CLINICAL STUDIES

1. 1 Trichomoniasis Tinidazole (2 g single oral dose) use in trichomoniasis has been well documented in 34 published reports from the world literature involving over 2,800 patients treated with tinidazole

INDICATIONS AND USAGE

STROMECTOL is indicated for the treatment of the following infections: Strongyloidiasis of the intestinal tract. STROMECTOL is indicated for the treatment of intestinal (i.e., nondisseminated) strongyloidiasis due to the nematode parasite Strongyloides stercoralis.

The medication of choice to treat parasitic infections is tinidazole for trichomoniasis, giardiasis, intestinal amebiasis, and amebic liver abscess, and ivermectin for strongyloidiasis and onchocerciasis.

• Tinidazole is effective against:
  • Trichomoniasis
  • Giardiasis
  • Intestinal amebiasis
  • Amebic liver abscess
• Ivermectin is effective against:
  • Strongyloidiasis
  • Onchocerciasis 2 3

From the Research

Medication Options for Parasitic Infections

The following medications are commonly used to treat parasitic infections:

• Albendazole: effective against ascariasis, enterobiosis, and hookworm infections, with cure rates of 88% for Ascaris lumbricoides and 72% for hookworm 4, 5
• Mebendazole: effective against ascariasis and enterobiosis, but less effective against hookworm infections, with cure rates of 95% for Ascaris lumbricoides and 15% for hookworm 4, 5
• Ivermectin: effective against Strongyloides stercoralis, with cure rates of 93.1% to 96.8%, and also used to treat onchocerciasis and lymphatic filariasis 4, 6
• Praziquantel: effective against intestinal trematode infections, with cure rates of 97% to 100%, and also used to treat schistosomiasis and adult cestode infections 4, 6
• Metronidazole: effective against blastocystosis, with parasitological cure and clinical improvement observed in patients with concomitant ascariasis, enterobiosis, and lambliasis 7

Treatment Considerations

When treating parasitic infections, the following considerations should be taken into account:

• The type of parasite and the severity of the infection
• The patient's age, weight, and medical history
• The potential for drug interactions and side effects
• The need for combination therapy or alternative treatments in cases of resistance or intolerance 4, 6

Efficacy of Medications

The efficacy of medications for parasitic infections can vary depending on the specific parasite and the treatment regimen:

• Albendazole and mebendazole have high cure rates against Ascaris lumbricoides, but lower cure rates against Trichuris trichiura and hookworm 5
• Ivermectin has high cure rates against Strongyloides stercoralis, but may not be effective against all types of parasites 4, 6
• Praziquantel has high cure rates against intestinal trematode infections, but may not be effective against all types of trematodes 4, 6