Helminthiasis
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General Notes
Prevention: transmission of helminths can be reduced by measures such as thorough cooking of meat and fish, use of latrines, wearing shoes, washing hands. Attention to the hands and nails is particularly important in the case of pinworm. Health promotion to prevent re-infection is very important. Endemic districts can conduct Mass Drug/medicine Administration (MDA) once a year.
The diagnosis should be confirmed by examination of stool for helminths and stool microscopy for eggs; peri-anal swab placed in saline for pinworm.
In the case of pinworm, threadworms (enterobius), the whole family should be treated. The first-choice treatment for all of the above infestations is albendazole, a broad-spectrum anthelmintic. Note also that treatment of bilharzia with praziquantel would also have eliminated roundworms.
Caution: Safety in pregnancy has not been established for albendazole; do NOT use in the first trimester of pregnancy. In most cases, treatment can be given AFTER delivery.
All Roundworms except Strongyloides
|
Medicine |
Adult Dose |
Frequency |
Duration |
|
Albendazole po |
400mg (<2yrs = 200mg) |
one dose only |
- |
Tapeworm and Strongyloides
|
Medicine |
Adult Dose |
Frequency |
Duration |
|
Albendazole po |
400mg (<2yrs = 200mg) |
once a day |
for 3 days* |
*If not cured after 3 weeks, repeat the course.
Cutaneous larva migrans ("sandworm")
|
Medicine |
Adult Dose |
Frequency |
Duration |
|
Albendazole po |
400mg (<2yrs = 200mg) |
once a day |
for 7 days |
Cysticercosis and Neurocysticercosis
Specialist inpatient treatment is required.
|
|
Medicine |
Adult Dose |
Frequency |
Duration |
|
|
Praziquantel po |
17mg/kg |
3 times a day |
for 15 days |
|
and |
prednisolone po |
15mg |
2 times a day |
for 18 days* |
*prednisolone therapy must start 2-3 days before praziquantel
Hydatid Disease
Refer to central hospital. Serological confirmation is required before treatment commenced.
Do not aspirate the cysts. Surgery is the treatment of choice. If inoperable:
|
Medicine |
Adult Dose |
Frequency |
Duration |
|
Albendazole po |
3mg/kg |
3 times a day |
30 days, then wait 15 days (medicines free) Then repeat the cycle 4 times. |
Monitor progress with ultrasound.