From the Guidelines
Ivermectin treatment should be initiated with a dose of 200 μg/kg monthly for 3 months, in combination with doxycycline, to target microfilariae and reduce micofilarodermia in patients with onchocerciasis, while also considering the risk of loiasis co-infection and seeking specialist input. When treating onchocerciasis, it is essential to exclude loiasis prior to treatment and seek expert advice in cases of co-infection 1. The treatment regimen should include doxycycline PO 200 mg once daily for 6 weeks to target symbiotic Wolbachia, in addition to ivermectin 1.
Key Considerations
- Ivermectin should be repeated every 3–6 months until asymptomatic, then annually if necessary, for several years 1.
- The risk of severe adverse events associated with ivermectin treatment in areas co-endemic with loiasis should be carefully considered, particularly when the microfilaria load exceeds 8000 microfilaria/ml 1.
- Specialist input and urgent ophthalmology assessment are advised when treating onchocerciasis to manage potential ocular manifestations 1.
Treatment Regimen
- Doxycycline PO 200 mg once daily for 6 weeks
- Ivermectin PO 200 μg/kg monthly for 3 months
- Repeat ivermectin every 3–6 months until asymptomatic, then annually if necessary, for several years 1
From the FDA Drug Label
The recommended dosage of STROMECTOL for the treatment of strongyloidiasis is a single oral dose designed to provide approximately 200 mcg of ivermectin per kg of body weight. The recommended dosage of STROMECTOL for the treatment of onchocerciasis is a single oral dose designed to provide approximately 150 mcg of ivermectin per kg of body weight
Ivermectin Treatment:
- Strongyloidiasis: The treatment for strongyloidiasis is a single oral dose of ivermectin, with the dosage based on body weight, approximately 200 mcg/kg.
- Onchocerciasis: The treatment for onchocerciasis is a single oral dose of ivermectin, with the dosage based on body weight, approximately 150 mcg/kg. 2 2
From the Research
Ivermectin Treatment Efficacy
- Ivermectin has been shown to be highly effective against Strongyloides stercoralis infection, with a cure rate of 83% compared to 38% for albendazole 3.
- A study in northeastern Thailand found that a single dose of ivermectin (200 µg/kg) successfully eliminated S. stercoralis infection in asymptomatic individuals with a 100% cure rate 4.
- Ivermectin is also considered the drug of choice for onchocerciasis and strongyloidiasis infections, and has been shown to be effective in the treatment of gnathostomiasis and crusted scabies 5.
Comparison with Other Treatments
- A randomized, controlled noninferiority trial found that moxidectin (8 mg) had a cure rate of 93.7% against S. stercoralis infections, compared to 95.2% for ivermectin (200 μg/kg) 6.
- Although moxidectin was not found to be noninferior to ivermectin, the difference in cure rates was small, suggesting that moxidectin may be a safe and efficacious alternative to ivermectin for the treatment of S. stercoralis infection.
Safety and Adverse Reactions
- Ivermectin has been shown to have a low rate of adverse reactions, with the exception of treatment of loiasis and onchocerciasis, where the death of a high microfilarial load may cause severe encephalopathy 5.
- A study of ivermectin treatment for onchocerciasis found that the drug caused minimal side effects and appeared to be sufficiently free of severe adverse reactions to be used on a mass scale 7.