What is the recommended preparation and administration of ivermectin (antiparasitic medication) for the treatment of nasal myiasis?

Ivermectin Solution Preparation for Nasal Myiasis

For nasal myiasis, the most effective treatment is ivermectin irrigation using a solution prepared by diluting oral ivermectin (200 μg/kg) in normal saline, combined with oral ivermectin administration. 1

Preparation of Ivermectin Solution for Nasal Irrigation

1. Solution Preparation:

   • Dissolve oral ivermectin tablets (typically 3mg or 6mg tablets) in 10-20ml of normal saline
   • Ensure complete dissolution by crushing tablets finely before mixing
   • Filter the solution through sterile gauze to remove any undissolved particles

2. Administration Technique:

   • Position patient with head tilted forward over a basin
   • Using a syringe (without needle) or nasal irrigation device, gently irrigate each nasal cavity
   • Allow solution to remain in contact with nasal mucosa for 2-3 minutes
   • Have patient expel solution by blowing nose gently

Systemic Treatment Protocol

• Oral Ivermectin: 200 μg/kg body weight, administered as two doses 24 hours apart 2
• This dosage is consistent with FDA-approved dosing for parasitic infections

Expected Outcomes

• Rapid expulsion of larvae (typically within 15-30 minutes of irrigation) 1
• Mean maggot shedding time with oral ivermectin is approximately 24.60 ± 3.15 hours compared to 41.23 ± 4.23 hours with traditional methods 2
• Complete clearance typically occurs within 48 hours

Follow-up and Additional Measures

• Perform nasal endoscopy at 24 hours, 48 hours, and 7 days post-treatment to confirm complete clearance 2
• Consider adjunctive antibiotic therapy if secondary bacterial infection is present
• For severe cases with extensive tissue involvement, consider adding:
  • Nasal decongestants to reduce mucosal edema
  • Topical antiseptics for wound care

Special Considerations

• Rule out underlying conditions that may predispose to myiasis:

  • Mucocutaneous leishmaniasis 1
  • Atrophic rhinitis 3
  • Leprosy sequelae 3
  • Impaired nasal hygiene due to physical or mental disability 4

• For patients with extensive infestation:

  • Initial manual removal of visible larvae may be necessary before irrigation
  • Consider combination with traditional methods (turpentine oil application) for severe cases

Caution

• Ivermectin should not be used in patients with known hypersensitivity to the medication
• Monitor for potential adverse effects including edema, rash, headache, and ocular complaints 5
• Ensure proper technique to prevent aspiration of solution

This protocol offers significant advantages over traditional methods, including faster clearance, reduced morbidity, and shorter hospital stays 2.