What is the recommended treatment for cutaneous larva migrans in an adult weighing 130 pounds (approximately 59 kilograms)?

Treatment of Cutaneous Larva Migrans for an Adult Weighing 130 lbs (59 kg)

The first-line treatment for cutaneous larva migrans in an adult weighing 130 lbs (59 kg) is a single oral dose of ivermectin at 200 μg/kg (approximately 12 mg total dose). 1

Treatment Options

First-line Treatment:

• Ivermectin: 200 μg/kg as a single oral dose (approximately 12 mg for a 59 kg adult) 1
  • Highly effective with cure rates of 81-100% 2
  • Preferred for multiple or diffuse lesions
  • Well-tolerated with minimal side effects

Alternative Treatment:

• Albendazole: 400 mg orally daily for 3 days 1
  • Can be extended to 7 days for extensive or multiple lesions 3, 4
  • Cure rates range from 46-100% with a single dose 2
  • Complete resolution typically occurs within 72 hours of treatment initiation 5

Treatment Algorithm

1. Assess the extent of infection:

   • For localized, limited lesions: Single dose ivermectin 200 μg/kg
   • For multiple or extensive lesions: Consider either ivermectin or albendazole for 3-7 days

2. Consider patient factors:

   • For patients with normal immunity: Single dose treatment is typically sufficient 1
   • For immunocompromised patients: Extended treatment may be necessary

3. Monitor for resolution:

   • Most patients experience symptom improvement within 24-72 hours
   • Complete resolution typically occurs within one week

Clinical Considerations

• Diagnosis: Cutaneous larva migrans presents with characteristic serpiginous, pruritic tracks in the skin, typically on feet, buttocks, or areas in contact with contaminated soil 6

• Complications: Bacterial superinfection due to scratching is common and may require additional treatment 6

• Common Pitfalls:

  1. Ineffective physical treatments: Cryotherapy and other physical treatments targeting the leading edge of the track are often ineffective 2

  2. Inadequate treatment duration: Short courses may lead to treatment failure or recurrence, especially with extensive lesions 3, 4

  3. Failure to treat all lesions: Ensure all affected areas are identified and treated

• Follow-up: No specific follow-up is required if symptoms resolve completely. If symptoms persist after treatment, consider extending treatment duration or switching to the alternative medication.

Special Considerations

• Pregnancy: Ivermectin should be avoided in pregnancy; albendazole should be used with caution
• Children: Dosing should be adjusted by weight
• Severe cases: For extensive infection or complications, the 7-day albendazole regimen may be preferred 3, 4

The evidence strongly supports ivermectin as the most effective and well-tolerated treatment option for cutaneous larva migrans in adults, with albendazole as an excellent alternative when ivermectin is unavailable or contraindicated.