Is a 3 mg dose of ivermectin sufficient for a 78.2 kg male with larva migrans?

Treatment of Larva Migrans in a 78.2 kg Male

A single dose of ivermectin 200 μg/kg (approximately 15.6 mg or 5 tablets of 3 mg each) is the recommended treatment for this 78.2 kg male with larva migrans. 1, 2

Dosing Calculation

• For a 78.2 kg patient:
  • Recommended dose: 200 μg/kg × 78.2 kg = 15,640 μg = 15.6 mg
  • Using 3 mg tablets: 15.6 mg ÷ 3 mg = 5.2 tablets
  • Therefore, 5 tablets of 3 mg ivermectin should be administered

Treatment Approach

• Ivermectin should be administered as a single oral dose on an empty stomach with water 2
• According to FDA dosing guidelines, patients weighing 66-79 kg should receive 5 tablets of 3 mg ivermectin 2
• The American Society of Tropical Medicine and Hygiene recommends ivermectin as a single oral dose of 200 μg/kg for cutaneous larva migrans 1

Efficacy and Response

• Single-dose ivermectin therapy has shown cure rates of 81-100% for cutaneous larva migrans 3
• Response rates are higher (98%) in patients with only creeping dermatitis compared to those with associated hookworm folliculitis (66%) 4
• Improvement of symptoms typically occurs within 24-48 hours of treatment 1
• Complete resolution of skin lesions typically occurs within 7-14 days 1

Follow-up and Monitoring

• If symptoms persist after 1 week, re-evaluation is recommended 5
• In cases of treatment failure, consider:
  1. Administering a second dose of ivermectin
  2. Alternative treatment with albendazole 400 mg daily for 3 days 5
  3. In resistant cases, combination therapy with both ivermectin and albendazole may be effective 6

Important Considerations

• Exclude co-existing onchocerciasis or loiasis before administering ivermectin 5
• Ivermectin is generally well-tolerated with few adverse effects 1
• Bioavailability is increased when taken with food, which increases drug penetration into the epidermis 5
• No adjustment of ivermectin dosage is required for persons with renal impairment 5

Prevention of Recurrence

• Avoid walking barefoot on beaches or soil in endemic areas 1
• Decontaminate bedding and clothing by machine washing and drying using hot cycle 5
• For persistent or recurrent cases, environmental control measures may be necessary 1