Albendazole, anthelmintic for Nematode/Roundworm Infections (Ascariasis, Baylisascariasis, Enterobiasis, Filariasis, Hookworm Infections)

Albendazole, anthelmintic for Nematode/Roundworm Infections (Ascariasis, Baylisascariasis, Enterobiasis, Filariasis, Hookworm Infections)

Ascariasis
Albendazole is used for the treatment of ascariasis caused by Ascaris lumbricoides. Albendazole, ivermectin, and mebendazole are considered the drugs of choice for the treatment of ascariasis.

Baylisascariasis
Albendazole has been used in a limited number of patients for the treatment of baylisascariasis caused by Baylisascaris procyonis; however, no drug has been demonstrated to be effective for the treatment of this infection. B. procyonis, a common roundworm found in the small intestine of raccoons, can cause severe or fatal encephalitis (neural larva migrans) in birds and mammals (including humans) and also can cause ocular and visceral larva migrans in humans. Since 1981, there have been at least 12 cases of severe or fatal encephalitis caused by this roundworm in the US (CA, IL, MI, MN, NY, OR, PA) and 10 of these cases occurred in children 9 months to 6 years of age; cases of B. procyonis ocular larva migrans also have been reported in the US. Humans become infected by ingesting B. procyonis eggs after contact with infected raccoon feces. Because CNS damage can occur before symptom onset, treatment of symptomatic patients with anthelmintic or anti-inflammatory agents often will not improve outcome. However, the CDC and other clinicians state that use of an anthelmintic agent (i.e., albendazole 25-50 mg/kg daily for 10-20 days) started within 1-3 days of possible infection might prevent clinical disease by killing larvae before they enter the CNS. Therefore, immediate treatment is recommended in cases of probable infection, including known exposures such as ingestion of raccoon stool or contaminated soil. Some clinicians suggest that ivermectin, mebendazole, thiabendazole, or levamisole (not commercially available in the US) could be tried if albendazole is not available. Corticosteroid therapy also may be helpful, especially in ocular and CNS infections; ocular baylisascariasis has been treated successfully using laser photocoagulation therapy to destroy the intraretinal larvae.

Enterobiasis
Albendazole is used for the treatment of enterobiasis caused by Enterobius vermicularis (pinworm). Albendazole, mebendazole, and pyrantel pamoate are considered the drugs of choice for the treatment of enterobiasis.

Filariasis
Mansonella perstans Infections. Albendazole and mebendazole are recommended as the drugs of choice for the treatment of filariasis caused by Mansonella perstans Use of antihistamines or corticosteroids may be indicated to decrease allergic reactions secondary to disintegration of microfilariae following treatment of filarial infections.

Wuchereria and Brugia Infections. Although diethylcarbamazine (available in the US from the CDC) is considered the drug of choice for the treatment of filariasis caused by Wuchereria bancrofti or Brugia malayi ivermectin has been used (with or without albendazole) for the treatment of these infections. There is some evidence that a combined regimen of a single dose of albendazole with a single dose of diethylcarbamazine or ivermectin is more effective than any one drug alone for suppression of microfilaremia caused by W. bancrofti or B. malayi. A regimen of albendazole and ivermectin has been used effectively in patients co-infected with W. bancrofti and O. volvulus.

Loiasis. Albendazole has been used to reduce microfilaremia in the treatment of loiasis caused by Loa loa Diethylcarbamazine (available in the US from the CDC) usually is considered the drug of choice for Loa loa infections. Albendazole may be useful for treatment of loiasis when diethylcarbamazine is ineffective or cannot be used, but repeated courses may be necessary. Because rapid killing of microfilariae may provoke encephalopathy, albendazole may be the preferred alternative (rather than ivermectin) because of its slower onset of action.

Hookworm Infections
Cutaneous Larva Migrans. Albendazole is used for the treatment of cutaneous larva migrans (creeping eruption) caused by dog and cat hookworms. Although cutaneous larva migrans usually is self-limited with spontaneous cure after several weeks or months, albendazole, ivermectin, or topical thiabendazole are considered the drugs of choice when treatment is indicated.