Praziquantel Dosing for Pediatric Paragonimiasis
For pediatric paragonimiasis, administer praziquantel 75 mg/kg/day divided into three doses (25 mg/kg three times daily) for 2 consecutive days, given orally with food.
Standard Dosing Regimen
- The recommended dose is 75 mg/kg/day divided into three doses (25 mg/kg three times daily) for 2 consecutive days 1, 2, 3, 4
- All doses should be administered with food to optimize absorption 5
- This regimen applies to all pediatric age groups, including preschool-aged children (2-5 years) and school-aged children (6-15 years) 6
Evidence Supporting This Dosing
- Clinical trials in paragonimiasis patients demonstrated that 75 mg/kg/day for 2 days achieved cure rates of 85.7-100%, significantly higher than lower doses 1, 3
- The 75 mg/kg/day regimen showed 90.8-96.8% reduction in egg counts with a 97.6% cure rate, compared to only 71.1% cure rate with 45 mg/kg/day 1
- A study of 52 patients treated with 3 × 25 mg/kg for 2 consecutive days achieved 85.7% cure rate, with overall cure rate of 95.2% after retreatment of failures 3
- Seven of eight patients treated with 75 mg/kg/day for 2 days became ova-negative by day 90-120 post-treatment 4
Treatment Failures and Retreatment
- If sputum or stool specimens remain ova-positive at 3-4 months follow-up, retreat with the same regimen (75 mg/kg/day for 2-3 consecutive days) 3, 4
- One patient who received the total dose of 150 mg/kg spread over 4 days (rather than 2 consecutive days) remained ova-positive, suggesting that dose concentration over consecutive days is critical 4
Safety Profile
- Praziquantel is well-tolerated in pediatric patients with mild, transient side effects 3, 6
- Common adverse effects include headache, dizziness, nausea, diarrhea, stomach ache, and vomiting occurring within 3 hours post-treatment 3, 6, 4
- Urticaria may occur, possibly from antigen release from drug-damaged parasites 4
- No serious adverse events or abnormal hematological, biochemical, or urinalysis findings have been reported in pediatric paragonimiasis treatment 3
Critical Pitfalls to Avoid
- Never use praziquantel for suspected tapeworm (T. solium) infection without neuroimaging first, as it can precipitate cerebral edema, seizures, or death if neurocysticercosis is present 7
- Avoid splitting the total dose over more than 2-3 consecutive days, as this reduces efficacy 4
- Do not use dexamethasone concurrently if corticosteroids are needed, as it significantly reduces praziquantel serum levels; use prednisolone instead 5, 7
- Monitor antiepileptic drug levels (phenytoin, carbamazepine) during treatment, as levels may decrease 5