What is the treatment for trichinosis?

Treatment of Trichinosis

For trichinosis, treat with albendazole 400 mg orally once daily for 8-14 days plus corticosteroids for symptomatic disease, as this regimen provides superior tolerability compared to alternatives and addresses both the enteral and parenteral phases of infection. 1

Disease Phases and Treatment Timing

Trichinosis progresses through two distinct phases that influence treatment efficacy:

• Enteral phase (7-30 days post-infection): Adult worms mature in the intestinal tract, causing upper abdominal pain, fever, vomiting, and diarrhea 1
• Parenteral phase (2-6 weeks post-infection): Larvae migrate to muscle tissue causing severe myalgia, muscle weakness, periorbital and facial edema, conjunctivitis, dysphagia, and urticarial rash 1

Treatment is most effective during the enteral phase (100% larval reduction) but remains beneficial during the parenteral phase (71% reduction), so initiate therapy regardless of disease stage 2

Recommended Treatment Regimen

Mild Disease

• Albendazole 400 mg orally once daily for 3 days 1
• Consider extending to 8-14 days for more complete parasite clearance 1, 3

Severe Disease (requiring intensive care, myocarditis, meningoencephalitis, or respiratory failure)

• Albendazole 400 mg orally once daily for 8-14 days PLUS prednisone 1, 4
• Corticosteroids address the inflammatory response causing severe symptoms 4
• Seek specialist advice for intensive care management 3

Alternative Agent: Mebendazole

Mebendazole is an acceptable alternative but less preferred due to inferior tolerability:

• Mebendazole 200-500 mg orally twice daily for 10-14 days 1, 3, 5
• A comparative study showed equivalent efficacy between albendazole and thiabendazole, but albendazole had significantly fewer side effects (0% vs 27%, P=0.01) 6
• Mebendazole demonstrated clinical improvement in 100% of treated patients versus 50% with placebo (P<0.05) 5

Critical Treatment Considerations

Albendazole should be taken with fatty meals to enhance absorption, as it is a lipophilic drug 4

Monitor for severe complications requiring intensive care:

• Respiratory failure from muscle weakness 1
• Myocarditis and cardiac conduction disturbances 1
• Meningoencephalitis 1

Laboratory monitoring should include:

• Elevated creatinine kinase (frequently seen) 1
• Eosinophil count (typically >3 × 10⁹/L) 1

Diagnosis to Guide Treatment

Serology or muscle biopsy confirms diagnosis, with seroconversion occurring 3-5 weeks post-infection 1

Treatment should not be delayed while awaiting confirmatory testing if clinical presentation is consistent with trichinosis (myalgia, periorbital edema, eosinophilia) and there is epidemiologic exposure to undercooked pork or wild game 1, 4

Common Pitfalls

Do not use thiabendazole as first-line therapy despite historical use, as 30% of patients cannot tolerate side effects 5

Do not withhold corticosteroids in severe disease due to concerns about parasite persistence—the inflammatory response causes the most significant morbidity and mortality 4

Recognize that treatment efficacy decreases once larvae encyst in muscle tissue, so early initiation is critical 1, 2

Expected Outcomes and Follow-up

Midterm symptoms persist in many patients despite treatment:

• 81% report ongoing myalgias at 6 months 6
• 69% report persistent fatigue at 6 months 6
• Relapses occur in approximately 15-27% of cases, more commonly with suboptimal treatment duration 6

Prevention requires education about thoroughly cooking pork and wild game meat, as public education alone is insufficient and should be augmented with mandatory meat testing when feasible 4