Treatment Dose of Ivermectin for Strongyloidiasis
The recommended treatment dose for strongyloidiasis is ivermectin 200 mcg/kg orally for 2 consecutive days, which provides cure rates approaching 100% with excellent tolerability. 1, 2
Standard Dosing Regimen
- Ivermectin 200 mcg/kg (0.2 mg/kg) orally for 2 consecutive days is the optimal regimen for uncomplicated chronic strongyloidiasis, achieving 100% cure rates compared to 77% with single-dose therapy 2
- The medication must be taken on an empty stomach with water to optimize bioavailability 3, 4
- This two-day regimen is superior to the FDA-labeled single-dose approach, which was based on older data 4, 2
Immunocompromised Patients
- For immunocompromised patients, use an extended regimen: ivermectin 200 mcg/kg on days 1,2,15, and 16 3, 1
- This population requires more aggressive treatment due to the risk of hyperinfection syndrome, which can be fatal 1
- Always screen and treat for strongyloidiasis before initiating corticosteroids or other immunosuppressive therapy 1
Weight-Based Dosing Table
The FDA provides specific tablet counts for the 200 mcg/kg dose using 3-mg tablets 4:
- 15-24 kg: 1 tablet
- 25-35 kg: 2 tablets
- 36-50 kg: 3 tablets
- 51-65 kg: 4 tablets
- 66-79 kg: 5 tablets
- ≥80 kg: calculate 200 mcg/kg
Alternative Regimen (Less Effective)
- A single dose of ivermectin 200 mcg/kg achieves only 77-97% cure rates 2, 5
- Albendazole 400 mg daily for 3 days is significantly less effective (38-63% cure rate) and should be reserved for situations where ivermectin is unavailable 1, 2
Critical Safety Considerations
- Always exclude Loa loa infection before administering ivermectin in anyone who has traveled to endemic regions in Africa, as hypermicrofilaremic patients (>8,000 mf/mL) risk severe adverse events including encephalitis 3, 6
- No dose adjustment is needed for renal impairment, but use caution with multiple doses in severe liver disease 3, 6
- Exercise particular caution in frail elderly patients, as one study showed increased mortality in this population, though this has not been confirmed in subsequent reports 3
Follow-Up and Cure Assessment
- Perform follow-up stool examinations to verify eradication of infection 4
- Monitor for persistent eosinophilia after treatment, which correlates with treatment failure (77% not-cure rate when eosinophilia persists) 2
- Consider retreatment if parasitological cure is not achieved 1