What is the recommended dose of ivermectin for treating intestinal worms causing vomiting?

Ivermectin Dosing for Intestinal Worms Causing Vomiting

For intestinal worms causing vomiting, the recommended dose of ivermectin is 200 mcg/kg (micrograms per kilogram) as a single oral dose. 1

Appropriate Dosing Based on Type of Worm

The specific dosing of ivermectin depends on the type of intestinal helminth infection:

Strongyloidiasis (Strongyloides stercoralis)

• Dose: 200 mcg/kg as a single oral dose 1
• Take on an empty stomach with water 2
• Follow-up stool examinations should be performed to verify eradication 1

Weight-Based Dosing for Strongyloidiasis

Body Weight (kg)	Number of 3-mg Tablets
15-24	1 tablet
25-35	2 tablets
36-50	3 tablets
51-65	4 tablets
66-79	5 tablets
≥80	Calculate 200 mcg/kg

Other Common Intestinal Worms

• Ascaris lumbricoides (roundworm): 200 mcg/kg as a single dose - highly effective with cure rates approaching 100% 3
• Trichuris trichiura (whipworm): 200 mcg/kg, but has limited efficacy (only about 11% cure rate) 3
• Hookworm infections: Ivermectin is largely ineffective; albendazole 400 mg is preferred 3
• Enterobius vermicularis (pinworm): 200 mcg/kg as a single dose 4

Special Considerations

Potential Contraindications

• Always exclude co-existing Loa loa infection before administering ivermectin in patients who have traveled to endemic regions 4
• Not recommended for children weighing less than 15 kg due to limited safety data 2

Treatment Failure

• For persistent strongyloidiasis, a repeat dose may be necessary 1
• For hyperinfection syndrome (severe strongyloidiasis with systemic symptoms):
  • More intensive treatment is required: ivermectin 200 mcg/kg on days 1,2,15, and 16 4
  • Seek specialist advice for immunocompromised patients 4

Side Effects

• Generally well-tolerated with mild, transient side effects 5
• In patients with high worm burdens, monitor for potential Mazzotti reaction (fever, headache, dizziness, rash, pruritus, tachycardia) 4

Follow-up

• Stool examination should be performed 2-4 weeks after treatment to confirm clearance of infection 1
• If symptoms persist or recur, consider:
  1. Resistance to treatment
  2. Reinfection
  3. Incorrect initial diagnosis
  4. Need for alternative antiparasitic medication

Remember that vomiting worms may indicate a high parasite burden, which could require more careful monitoring for side effects during treatment.