Dosage of Albendazole for Nematode/Roundworm Infections (Baylisascariasis, Enterobiasis, Filariasis, Hookworm Infections, Toxocariasis, Strongyloidiasis, Trichinellosis, Trichostrongyliasis, Trichuriasis, Trematode, Giardiasis, Microsporidiosis)
Nematode (Roundworm) Infections
Ascariasis. For the treatment of ascariasis caused by Ascaris lumbricoides, adult and pediatric patients should receive a single 400-mg dose of albendazole.
Baylisascariasis. In an attempt to prevent clinical disease by killing larvae before they enter the CNS, the US Centers for Disease Control and Prevention (CDC) recommends early (with 1-3 days of possible infection) albendazole therapy at a dosage of 25-50 mg/kg daily for 10 days. Some clinicians recommend a 20-day course of albendazole therapy. Immediate treatment is recommended if infection is probable; treatment should not be delayed until the emergence of symptoms.
Enterobiasis. For the treatment of enterobiasis caused by Enterobius vermicularis (pinworm), some clinicians recommend that adult and pediatric patients receive an initial 400-mg dose of albendazole and a second 400-mg dose given 2 weeks later. Some clinicians recommend that all household contacts of patients with enterobiasis receive treatment, especially in situations in which multiple or repeated symptomatic infections occur, since such contacts commonly also are infected.
Filariasis. For the treatment of filariasis caused by Mansonella perstans, some clinicians recommend that adults and pediatric patients receive albendazole in a dosage of 400 mg twice daily for 10 days.
Hookworm Infections. For the treatment of cutaneous larva migrans (creeping eruption) caused by dog or cat hookworms, some clinicians recommend that adults and pediatric patients receive albendazole in a dosage of 400 mg once daily for 3 days.
For the treatment of intestinal hookworm infections caused by Ancylostoma duodenale or Necator americanus, some clinicians recommend that adult and pediatric patients receive a single 400-mg dose of albendazole. A repeat stool examination (using a concentration technique) for eggs of A. duodenale or N. americanus should be performed 2 weeks after treatment and the regimen should be repeated if results are positive.
For the treatment of eosinophilic enterocolitis caused by Ancylostoma caninum (dog hookworm), some clinicians recommend that adult and pediatric patients receive a single 400 mg dose of albendazole.
Toxocariasis (Visceral Larva Migrans). For the treatment of treatment of toxocariasis (visceral larva migrans) caused by dog and cat roundworms, some clinicians recommend that adults and pediatric patients receive albendazole in a dosage of 400 mg twice daily for 5 days. However, optimum duration of therapy is not known and some clinicians recommend that treatment be continued for up to 20 days.
Strongyloidiasis. For the treatment of strongyloidiasis caused by Strongyloides stercoralis (threadworm), some clinicians recommend that adults and pediatric patients receive albendazole in a dosage of 400 mg twice daily for 2 days. It may be necessary to repeat or prolong therapy or use other agents in immunocompromised individuals or those with disseminated disease.
Trichinellosis. The recommended dosage of albendazole for the treatment of trichinellosis (trichinosis) caused by Trichinella spiralis in adults and pediatric patients is 400 mg twice daily for 8-14 days.
Trichostrongyliasis. For the treatment of infections caused by Trichostrongylus, adults and pediatric patients should receive a single 400-mg dose of albendazole.
Trichuriasis. Adults and pediatric patients with trichuriasis caused by Trichuris trichiura (whipworm) should receive albendazole in a dosage of 400 mg once daily for 3 days.
Other Nematode Infections. For the treatment of capillariasis caused by Capillaria philippinensis, some clinicians recommend that adults and pediatric patients receive albendazole in a dosage of 400 mg once daily for 10 days.
Adults and pediatric patients with gnathostomiasis caused by Gnathostoma spinigerum should receive albendazole in a dosage of 400 mg twice daily for 21 days.
For the treatment of gongylonemiasis caused by Gongylonema, adults and pediatric patients should receive albendazole in a dosage of 10 mg/kg daily for 3 days.
Trematode (Fluke) Infections
For the treatment of infections caused by Clonorchis sinensis (Chinese liver fluke), some clinicians recommend that adults and pediatric patients receive albendazole in a dosage of 10 mg/kg daily given for 7 days.
Giardiasis
For the treatment of giardiasis caused by Giardia duodenalis (also known as G. lamblia or G. intestinalis) in adults and pediatric patients, albendazole has been given in a dosage of 400 mg daily for 5 days (alone or in conjunction with metronidazole).
Microsporidiosis
For the treatment of ocular or disseminated microsporidiosis, some clinicians recommend that adults receive albendazole in a dosage of 400 mg twice daily. For the treatment of intestinal microsporidiosis caused by Encephalitozoon intestinalis, some clinicians recommend that adults receive albendazole in a dosage of 400 mg twice daily for 21 days.
Minggu, 27 Juli 2014
Dosage of Albendazole for Neurocysticercosis and Hydatid Disease.
Dosage of Albendazole for Neurocysticercosis and Hydatid Disease.
Cestode (Tapeworm) Infections
Neurocysticercosis. Because of its activity against the pork tapeworm (T. solium), albendazole therapy for the treatment of neurocysticercosis resulting from active lesions caused by Cysticercus cellulosae (the larval form of T. solium) has been associated with adverse CNS effects (e.g., seizures and/or hydrocephalus) resulting from inflammatory reactions to damaged intracerebral cysts. Therefore, patients receiving albendazole for the treatment of neurocysticercosis should receive appropriate corticosteroid and anticonvulsant therapy as required. Oral or IV corticosteroid therapy should be considered during the first week of albendazole treatment to prevent cerebral hypertension.
Although retinal cysticercosis is rare, patients with neurocysticercosis may have retinal lesions, and destruction of cysticercal lesions by albendazole may cause retinal damage. Therefore, patients should be examined for retinal lesions, and, if any are present, the need for treatment of patients with neurocysticercosis should be weighed against the possibility of retinal damage resulting from albendazole use.
For the treatment of neurocysticercosis in adults and children 6 years of age and older and weighing 60 kg or more, the usual dosage of albendazole is 400 mg given twice daily with meals for 8-30 days. For the treatment of neurocysticercosis in patients weighing less than 60 kg, the usual daily dosage of albendazole is 15 mg/kg daily (not to exceed 800 mg daily), administered as 2 equally divided doses with meals, for 8-30 days. Courses of therapy may be repeated as necessary.
Hydatid Disease. Surgery is considered the treatment of choice for hydatid disease, when medically feasible, and albendazole is administered either before or after surgery. When albendazole is used for the adjunctive perioperative treatment of hydatid disease, optimal killing of cyst contents is achieved by administering the drug in three 28-day courses of therapy, separated by two 14-day albendazole-free intervals.
For the treatment of cystic hydatid disease of the liver, lung, or peritoneum caused by the larval form of the dog tapeworm (Echinococcus granulosus) in adults or children 6 years of age and older and weighing 60 kg or more, the usual dosage of albendazole is 400 mg twice daily given with meals for 28 days, followed by a 14-day albendazole-free interval for a total of 3 dosage cycles. For patients weighing less than 60 kg, the usual dosage is 15 mg/kg daily (not to exceed 800 mg daily), administered in 2 equally divided doses with meals for 28 days, followed by a 14-day albendazole-free interval for a total of 3 dosage cycles. Some clinicians recommend that adults receive 400 mg of albendazole twice daily and that pediatric patients receive 15 mg/kg daily (not to exceed 800 mg daily) for 1-6 months for the treatment of hydatid cyst disease.
Cestode (Tapeworm) Infections
Neurocysticercosis. Because of its activity against the pork tapeworm (T. solium), albendazole therapy for the treatment of neurocysticercosis resulting from active lesions caused by Cysticercus cellulosae (the larval form of T. solium) has been associated with adverse CNS effects (e.g., seizures and/or hydrocephalus) resulting from inflammatory reactions to damaged intracerebral cysts. Therefore, patients receiving albendazole for the treatment of neurocysticercosis should receive appropriate corticosteroid and anticonvulsant therapy as required. Oral or IV corticosteroid therapy should be considered during the first week of albendazole treatment to prevent cerebral hypertension.
Although retinal cysticercosis is rare, patients with neurocysticercosis may have retinal lesions, and destruction of cysticercal lesions by albendazole may cause retinal damage. Therefore, patients should be examined for retinal lesions, and, if any are present, the need for treatment of patients with neurocysticercosis should be weighed against the possibility of retinal damage resulting from albendazole use.
For the treatment of neurocysticercosis in adults and children 6 years of age and older and weighing 60 kg or more, the usual dosage of albendazole is 400 mg given twice daily with meals for 8-30 days. For the treatment of neurocysticercosis in patients weighing less than 60 kg, the usual daily dosage of albendazole is 15 mg/kg daily (not to exceed 800 mg daily), administered as 2 equally divided doses with meals, for 8-30 days. Courses of therapy may be repeated as necessary.
Hydatid Disease. Surgery is considered the treatment of choice for hydatid disease, when medically feasible, and albendazole is administered either before or after surgery. When albendazole is used for the adjunctive perioperative treatment of hydatid disease, optimal killing of cyst contents is achieved by administering the drug in three 28-day courses of therapy, separated by two 14-day albendazole-free intervals.
For the treatment of cystic hydatid disease of the liver, lung, or peritoneum caused by the larval form of the dog tapeworm (Echinococcus granulosus) in adults or children 6 years of age and older and weighing 60 kg or more, the usual dosage of albendazole is 400 mg twice daily given with meals for 28 days, followed by a 14-day albendazole-free interval for a total of 3 dosage cycles. For patients weighing less than 60 kg, the usual dosage is 15 mg/kg daily (not to exceed 800 mg daily), administered in 2 equally divided doses with meals for 28 days, followed by a 14-day albendazole-free interval for a total of 3 dosage cycles. Some clinicians recommend that adults receive 400 mg of albendazole twice daily and that pediatric patients receive 15 mg/kg daily (not to exceed 800 mg daily) for 1-6 months for the treatment of hydatid cyst disease.
Drug Administration of Albendazole
Drug Administration of Albendazole
Albendazole is administered orally with food. Oral bioavailability of albendazole appears to be increased when the drug is administered with a fatty meal; when the drug is administered with meals containing about 40 g of fat, plasma concentrations of albendazole sulfoxide are up to 5 times higher than those observed when the drug is administered to fasting patients.
In patients who have difficulty swallowing tablets whole (particularly young children), albendazole tablets may be crushed or chewed and swallowed with a drink of water.
Albendazole may cause harm to the fetus and should be used during pregnancy only if the benefits justify the risk to the fetus and only when no alternative management is appropriate. Women of childbearing age should begin treatment only after a negative pregnancy test, and should be cautioned against becoming pregnant while receiving albendazole or within 1 month of completing treatment with the drug.
Because albendazole has been associated with mild to moderate increases of hepatic enzymes in about 16% of patients receiving the drug in clinical trials, and may cause hepatotoxicity, liver function tests should be performed prior to each course of albendazole therapy and at least every 2 weeks during treatment with the drug. If hepatic enzyme concentrations exceed twice the upper limit of normal, consideration should be given to discontinuance of the drug based on the individual patient circumstance. Decisions to reinstitute albendazole when hepatic enzymes return to pretreatment levels should be individualized taking into account the risks and benefits of further albendazole treatment. If the drug is reinstituted, laboratory tests should be performed frequently.
Leukopenia has occurred in less than 1% of patients receiving albendazole, and rarely, granulocytopenia, pancytopenia, agranulocytosis, or thrombocytopenia has been reported. Therefore, blood counts should be performed at the start of, and every 2 weeks during, each 28-day treatment cycle. Albendazole should be discontinued if clinically important decreases in blood cell counts occur.
Albendazole is administered orally with food. Oral bioavailability of albendazole appears to be increased when the drug is administered with a fatty meal; when the drug is administered with meals containing about 40 g of fat, plasma concentrations of albendazole sulfoxide are up to 5 times higher than those observed when the drug is administered to fasting patients.
In patients who have difficulty swallowing tablets whole (particularly young children), albendazole tablets may be crushed or chewed and swallowed with a drink of water.
Albendazole may cause harm to the fetus and should be used during pregnancy only if the benefits justify the risk to the fetus and only when no alternative management is appropriate. Women of childbearing age should begin treatment only after a negative pregnancy test, and should be cautioned against becoming pregnant while receiving albendazole or within 1 month of completing treatment with the drug.
Because albendazole has been associated with mild to moderate increases of hepatic enzymes in about 16% of patients receiving the drug in clinical trials, and may cause hepatotoxicity, liver function tests should be performed prior to each course of albendazole therapy and at least every 2 weeks during treatment with the drug. If hepatic enzyme concentrations exceed twice the upper limit of normal, consideration should be given to discontinuance of the drug based on the individual patient circumstance. Decisions to reinstitute albendazole when hepatic enzymes return to pretreatment levels should be individualized taking into account the risks and benefits of further albendazole treatment. If the drug is reinstituted, laboratory tests should be performed frequently.
Leukopenia has occurred in less than 1% of patients receiving albendazole, and rarely, granulocytopenia, pancytopenia, agranulocytosis, or thrombocytopenia has been reported. Therefore, blood counts should be performed at the start of, and every 2 weeks during, each 28-day treatment cycle. Albendazole should be discontinued if clinically important decreases in blood cell counts occur.
Albendazole anthelmintic for Cestode/Tapeworm Infections (Neurocysticercosis, Hydatid Disease)
Albendazole anthelmintic for Cestode/Tapeworm Infections (Neurocysticercosis, Hydatid Disease)
Albendazole ( C12H15N3O2S ) is used in the treatment of tissue infections caused by the larval forms of certain cestodes (tapeworms) including neurocysticercosis caused by ysticercus cellulosae, the larval form of Taenia solium (pork tapeworm). Albendazole also is used for the treatment of hydatid disease caused by the larval form of Echinococcus granulosus (dog tapeworm). Other anthelmintics (usually praziquantel or nitazoxanide) are used for the treatment of intestinal infections caused by adult forms of cestodes.
Neurocysticercosis
Albendazole is used for the treatment of parenchymal neurocysticercosis resulting from active lesions caused by Cysticercus cellulosae, the larval form of Taenia solium (pork tapeworm), preferably in combination with corticosteroids. Symptoms commonly associated with neurocysticercosis include headaches, seizures, or other CNS effects thought to result from expanding active cysticercal lesions or edema surrounding individual degenerating cysts in brain parenchyma. Therefore, important measures of response to antineurocysticercal therapy include resolution of CNS symptoms and radiologic response.
The manufacturer states that safety and efficacy of albendazole in patients with neurocysticercosis caused by T. solium was demonstrated by analysis of 3 sets of data, including a compilation of data from published reports of albendazole use in neurocysticercosis, data from US compassionate use patients, and data from one limited clinical study. In studies of patients with susceptible neurocysticercal lesions (i.e., nonenhancing cysts with no surrounding edema on contrast-enhanced computerized tomography) receiving albendazole, the number of cysts was reduced by 74-88%, and resolution of all active cysts occurred in 40-70% of patients. Combining two of the data sets (the report compilation and the US compassionate use data), the manufacturer states that about 41% of patients experienced a cure (no symptoms of neurocysticercosis), about 50% of patients were considered to be improved, and 9% experienced no change. Corticosteroids are used concomitantly to reduce the frequency and severity of adverse nervous system effects (CSF reaction syndrome), associated with albendazole therapy for neurocysticercosis. Anticonvulsant therapy also may be necessary.
Use of anthelmintics (albendazole or praziquantel) in the treatment of cysticercosis is controversial since efficacy has not been proven in controlled studies. Initial treatment of parenchymal disease with seizures should focus on symptomatic treatment with anticonvulsants. Obstructive hydrocephalus is treated with surgical removal of the obstructing cyst or CSF diversion and prednisone; arachnoiditis, vasculitis, or cerebral edema is treated with corticosteroids (prednisone or dexamethasone) used in conjunction with albendazole or praziquantel. Even when corticosteroids are used, any cysticercocidal drug may cause irreparable damage when used to treat ocular or spinal cysts, and ophthalmic exams should be performed before treatment to rule out intraocular cysts
Hydatid Disease
Albendazole is used for the treatment of cystic hydatid disease (unilocular hydatid disease) of the liver, lung, and peritoneum, caused by the larval form of the dog tapeworm (Echinococcus granulosus). Surgery is considered to be the treatment of choice for hydatid disease, when medically feasible, but perioperative administration of an anthelmintic drug (e.g., albendazole, mebendazole, praziquantel) may be indicated in patients undergoing surgical removal of cysts to minimize the risk of intraoperative dissemination of daughter cysts. Percutaneous drainage with ultrasound guidance plus albendazole therapy has been effective for the management of hepatic hydatid cyst disease.
Albendazole is absorbed to a greater extent, and achieves higher plasma concentrations (as its active metabolite) than mebendazole, and some clinicians consider albendazole to be a drug of choice for treatment of hydatid cyst disease caused by E. granulosus. Risks associated with surgery include operative morbidity, cyst recurrence, and anaphylaxis or dissemination of infection resulting from spillage of fluid from the cysts. Preoperative administration of albendazole may inactivate protoscolices and minimize the possibility of recurring cysts, and postoperative treatment with the drug may prevent secondary dissemination of the cestode that can occur after spontaneous or operative rupture and spillage of cyst contents. Optimal cysticidal effect of albendazole is achieved preoperatively or postoperatively when the drug is administered in three 28-day courses of therapy. Also, some clinicians have recommended administration of albendazole in patients with inoperable, widespread, or numerous E. granulosus cysts, or in patients with complex medical problems who are not eligible for surgery.
The manufacturer states that because of the low incidence of hydatid disease, safety and efficacy of albendazole in patients with hydatid disease caused by E. granulosus was demonstrated by combining data from accumulated clinical reports in small series of patients. Four sets of data were considered, including data from European compassionate use patients, an analysis of data from published studies, data from Australian compassionate use patients (not evaluable), and data from US compassionate use patients. About 80-90% of patients receiving albendazole in three 28-day cycles had noninfectious cyst contents. About 30-31% of evaluable patients with hydatid disease receiving albendazole experienced a clinical cure (i.e., disappearance of cysts), and improvement (i.e., a reduction in cyst diameter of at least 25%) was observed in about 40-42% of evaluable patients. About 24% of patients receiving albendazole experienced no change or were considered to be worse.
Although albendazole has been used to treat alveolar hydatid disease, another form of hydatid cyst disease caused by Echinococcus multilocularis, surgical excision of the larval mass is the recommended and only reliable treatment for this infection. Continuous albendazole or mebendazole therapy reportedly has been associated with clinical improvement in nonresectable cases, but the manufacturer states that efficacy of albendazole in the treatment of alveolar hydatid disease caused by E. multilocularis has not been clearly demonstrated in clinical studies.
Albendazole ( C12H15N3O2S ) is used in the treatment of tissue infections caused by the larval forms of certain cestodes (tapeworms) including neurocysticercosis caused by ysticercus cellulosae, the larval form of Taenia solium (pork tapeworm). Albendazole also is used for the treatment of hydatid disease caused by the larval form of Echinococcus granulosus (dog tapeworm). Other anthelmintics (usually praziquantel or nitazoxanide) are used for the treatment of intestinal infections caused by adult forms of cestodes.
Neurocysticercosis
Albendazole is used for the treatment of parenchymal neurocysticercosis resulting from active lesions caused by Cysticercus cellulosae, the larval form of Taenia solium (pork tapeworm), preferably in combination with corticosteroids. Symptoms commonly associated with neurocysticercosis include headaches, seizures, or other CNS effects thought to result from expanding active cysticercal lesions or edema surrounding individual degenerating cysts in brain parenchyma. Therefore, important measures of response to antineurocysticercal therapy include resolution of CNS symptoms and radiologic response.
The manufacturer states that safety and efficacy of albendazole in patients with neurocysticercosis caused by T. solium was demonstrated by analysis of 3 sets of data, including a compilation of data from published reports of albendazole use in neurocysticercosis, data from US compassionate use patients, and data from one limited clinical study. In studies of patients with susceptible neurocysticercal lesions (i.e., nonenhancing cysts with no surrounding edema on contrast-enhanced computerized tomography) receiving albendazole, the number of cysts was reduced by 74-88%, and resolution of all active cysts occurred in 40-70% of patients. Combining two of the data sets (the report compilation and the US compassionate use data), the manufacturer states that about 41% of patients experienced a cure (no symptoms of neurocysticercosis), about 50% of patients were considered to be improved, and 9% experienced no change. Corticosteroids are used concomitantly to reduce the frequency and severity of adverse nervous system effects (CSF reaction syndrome), associated with albendazole therapy for neurocysticercosis. Anticonvulsant therapy also may be necessary.
Use of anthelmintics (albendazole or praziquantel) in the treatment of cysticercosis is controversial since efficacy has not been proven in controlled studies. Initial treatment of parenchymal disease with seizures should focus on symptomatic treatment with anticonvulsants. Obstructive hydrocephalus is treated with surgical removal of the obstructing cyst or CSF diversion and prednisone; arachnoiditis, vasculitis, or cerebral edema is treated with corticosteroids (prednisone or dexamethasone) used in conjunction with albendazole or praziquantel. Even when corticosteroids are used, any cysticercocidal drug may cause irreparable damage when used to treat ocular or spinal cysts, and ophthalmic exams should be performed before treatment to rule out intraocular cysts
Hydatid Disease
Albendazole is used for the treatment of cystic hydatid disease (unilocular hydatid disease) of the liver, lung, and peritoneum, caused by the larval form of the dog tapeworm (Echinococcus granulosus). Surgery is considered to be the treatment of choice for hydatid disease, when medically feasible, but perioperative administration of an anthelmintic drug (e.g., albendazole, mebendazole, praziquantel) may be indicated in patients undergoing surgical removal of cysts to minimize the risk of intraoperative dissemination of daughter cysts. Percutaneous drainage with ultrasound guidance plus albendazole therapy has been effective for the management of hepatic hydatid cyst disease.
Albendazole is absorbed to a greater extent, and achieves higher plasma concentrations (as its active metabolite) than mebendazole, and some clinicians consider albendazole to be a drug of choice for treatment of hydatid cyst disease caused by E. granulosus. Risks associated with surgery include operative morbidity, cyst recurrence, and anaphylaxis or dissemination of infection resulting from spillage of fluid from the cysts. Preoperative administration of albendazole may inactivate protoscolices and minimize the possibility of recurring cysts, and postoperative treatment with the drug may prevent secondary dissemination of the cestode that can occur after spontaneous or operative rupture and spillage of cyst contents. Optimal cysticidal effect of albendazole is achieved preoperatively or postoperatively when the drug is administered in three 28-day courses of therapy. Also, some clinicians have recommended administration of albendazole in patients with inoperable, widespread, or numerous E. granulosus cysts, or in patients with complex medical problems who are not eligible for surgery.
The manufacturer states that because of the low incidence of hydatid disease, safety and efficacy of albendazole in patients with hydatid disease caused by E. granulosus was demonstrated by combining data from accumulated clinical reports in small series of patients. Four sets of data were considered, including data from European compassionate use patients, an analysis of data from published studies, data from Australian compassionate use patients (not evaluable), and data from US compassionate use patients. About 80-90% of patients receiving albendazole in three 28-day cycles had noninfectious cyst contents. About 30-31% of evaluable patients with hydatid disease receiving albendazole experienced a clinical cure (i.e., disappearance of cysts), and improvement (i.e., a reduction in cyst diameter of at least 25%) was observed in about 40-42% of evaluable patients. About 24% of patients receiving albendazole experienced no change or were considered to be worse.
Although albendazole has been used to treat alveolar hydatid disease, another form of hydatid cyst disease caused by Echinococcus multilocularis, surgical excision of the larval mass is the recommended and only reliable treatment for this infection. Continuous albendazole or mebendazole therapy reportedly has been associated with clinical improvement in nonresectable cases, but the manufacturer states that efficacy of albendazole in the treatment of alveolar hydatid disease caused by E. multilocularis has not been clearly demonstrated in clinical studies.
Albendazole, anthelmintic for nematode/roundworm infections (Intestinal Hookworm, Toxocariasis, Strongyloidiasis, Trichinellosis, Trichostrongyliasis, Trichuriasis,Trematode, Giardiasis, Microsporidiosis)
Albendazole, anthelmintic for nematode/roundworm infections (Intestinal Hookworm, Toxocariasis, Strongyloidiasis, Trichinellosis, Trichostrongyliasis, Trichuriasis,Trematode, Giardiasis, Microsporidiosis)
Intestinal Hookworm Infections. Albendazole is used for the treatment of intestinal hookworm infections caused by Ancylostoma duodenale or Necator americanus, and albendazole, mebendazole, or pyrantel pamoate are considered the drugs of choice for intestinal hookworm infections.
Albendazole, mebendazole, pyrantel pamoate, or endoscopic removal of worms is recommended for the treatment of eosinophilic enterocolitis caused by Ancylostoma caninum (dog hookworm).
Toxocariasis (Visceral Larva Migrans)
Albendazole is used for the treatment of toxocariasis (visceral larva migrans) caused by Toxocara canis or T. cati (dog and cat roundworms), and albendazole or mebendazole are considered the drugs of choice for these infections. In severe cases with cardiac, ocular, or CNS involvement, corticosteroids also may be indicated. Treatment may not be effective in ocular larva migrans; inflammation may be reduced by corticosteroid injections and surgery may be necessary for secondary damage.
Strongyloidiasis
Albendazole is used for the treatment of strongyloidiasiscaused by Strongyloides stercoralis (threadworm). Some clinicians consider ivermectin the drug of choice and albendazole and thiabendazole alternatives for the treatment of strongyloidiasis.
Trichinellosis
Albendazole is used for the treatment of trichinellosis (trichinosis) caused by Trichinella spiralis. Although some clinicians state that albendazole and mebendazole are equally effective for the treatment of trichinellosis, other clinicians consider mebendazole the drug of choice and albendazole the alternative agent. Use of corticosteroids in addition to the anthelmintic usually is recommended, especially when symptoms are severe. Corticosteroids alleviate symptoms of the inflammatory reaction and can be lifesaving when cardiac or CNS systems are involved.
Trichostrongyliasis
Albendazole is used in the treatment of trichostrongyliasis. Pyrantel pamoate is considered the drug of choice for the treatment of Trichostrongylus infections and albendazole and mebendazole are alternatives.
Trichuriasis
Albendazole is used as an alternative for the treatment of trichuriasis caused by Trichuris trichiura (whipworm). Mebendazole is considered the drug of choice and albendazole and ivermectin are alternatives for the treatment of trichuriasis.
Other Nematode Infections
Albendazole has been used in the treatment of capillariasis caused by Capillaria philippinensis. Mebendazole is considered the drug of choice for the treatment of capillariasis and albendazole is an alternative.
For the treatment of gnathostomiasis caused by Gnathostoma spinigerum, use of albendazole or ivermectin (with or without surgical removal) is recommended.
For the treatment of gongylonemiasis caused by Gongylonema, surgical removal or use of albendazole is recommended.
Albendazole or pyrantel pamoate may be effective for the treatment of oesophagostomiasis caused by Oesophagostomum bifurcum.
Trematode (Fluke) Infections
For the treatment of infections caused by Clonorchis sinensis (Chinese liver fluke), albendazole or praziquantel are recommended as the drugs of choice. Other anthelmintics (usually praziquantel) are recommended for all other fluke infections.
Giardiasis
Although metronidazole, tinidazole, or nitazoxanide generally are considered the drugs of choice for the treatment of giardiasis caused by Giardia duodenalis (also known as G. lamblia or G. intestinalis), albendazole therapy alone or used in conjunction with metronidazole may be effective for the treatment of giardiasis. Albendazole may be as effective as metronidazole for treating giardiasis in pediatric patients and has fewer adverse effects.
Microsporidiosis
Albendazole has been used in the treatment of microsporidiosis. Microsporidia can cause ocular infections (Encephalitozoon hellem, E. cuniculi, Vittaforma corneae), intestinal infections (Enterocytozoon bieneusi, Encephalitozoon intestinalis), and disseminated infections (E. hellem, E. cuniculi, E. intestinalis, Pleistophora, Trachipleistophora, Brachiola vesicularum). Intestinal infections are most common in immunocompromised patients, and are being reported with increasing frequency in patients with human immunodeficiency virus (HIV) infection. Some clinicians recommend use of albendazole in conjunction with fumagillin (not commercially available in the US) for the topical treatment of ocular microsporidiosis and also consider albendazole the drug of choice for intestinal infections caused by E. intestinalis and for disseminated microsporidiosis. Although some patients with intestinal microsporidiosis caused by E. intestinalis may respond to albendazole, the organism is not eradicated in all patients and recurrence of diarrhea is common after therapy is stopped. Patients with E. bieneusi infections generally do not respond to albendazole. Topical fumagillin therapy generally is not effective for ocular lesions caused by V. corneae, and keratoplasty may be necessary.
Intestinal Hookworm Infections. Albendazole is used for the treatment of intestinal hookworm infections caused by Ancylostoma duodenale or Necator americanus, and albendazole, mebendazole, or pyrantel pamoate are considered the drugs of choice for intestinal hookworm infections.
Albendazole, mebendazole, pyrantel pamoate, or endoscopic removal of worms is recommended for the treatment of eosinophilic enterocolitis caused by Ancylostoma caninum (dog hookworm).
Toxocariasis (Visceral Larva Migrans)
Albendazole is used for the treatment of toxocariasis (visceral larva migrans) caused by Toxocara canis or T. cati (dog and cat roundworms), and albendazole or mebendazole are considered the drugs of choice for these infections. In severe cases with cardiac, ocular, or CNS involvement, corticosteroids also may be indicated. Treatment may not be effective in ocular larva migrans; inflammation may be reduced by corticosteroid injections and surgery may be necessary for secondary damage.
Strongyloidiasis
Albendazole is used for the treatment of strongyloidiasiscaused by Strongyloides stercoralis (threadworm). Some clinicians consider ivermectin the drug of choice and albendazole and thiabendazole alternatives for the treatment of strongyloidiasis.
Trichinellosis
Albendazole is used for the treatment of trichinellosis (trichinosis) caused by Trichinella spiralis. Although some clinicians state that albendazole and mebendazole are equally effective for the treatment of trichinellosis, other clinicians consider mebendazole the drug of choice and albendazole the alternative agent. Use of corticosteroids in addition to the anthelmintic usually is recommended, especially when symptoms are severe. Corticosteroids alleviate symptoms of the inflammatory reaction and can be lifesaving when cardiac or CNS systems are involved.
Trichostrongyliasis
Albendazole is used in the treatment of trichostrongyliasis. Pyrantel pamoate is considered the drug of choice for the treatment of Trichostrongylus infections and albendazole and mebendazole are alternatives.
Trichuriasis
Albendazole is used as an alternative for the treatment of trichuriasis caused by Trichuris trichiura (whipworm). Mebendazole is considered the drug of choice and albendazole and ivermectin are alternatives for the treatment of trichuriasis.
Other Nematode Infections
Albendazole has been used in the treatment of capillariasis caused by Capillaria philippinensis. Mebendazole is considered the drug of choice for the treatment of capillariasis and albendazole is an alternative.
For the treatment of gnathostomiasis caused by Gnathostoma spinigerum, use of albendazole or ivermectin (with or without surgical removal) is recommended.
For the treatment of gongylonemiasis caused by Gongylonema, surgical removal or use of albendazole is recommended.
Albendazole or pyrantel pamoate may be effective for the treatment of oesophagostomiasis caused by Oesophagostomum bifurcum.
Trematode (Fluke) Infections
For the treatment of infections caused by Clonorchis sinensis (Chinese liver fluke), albendazole or praziquantel are recommended as the drugs of choice. Other anthelmintics (usually praziquantel) are recommended for all other fluke infections.
Giardiasis
Although metronidazole, tinidazole, or nitazoxanide generally are considered the drugs of choice for the treatment of giardiasis caused by Giardia duodenalis (also known as G. lamblia or G. intestinalis), albendazole therapy alone or used in conjunction with metronidazole may be effective for the treatment of giardiasis. Albendazole may be as effective as metronidazole for treating giardiasis in pediatric patients and has fewer adverse effects.
Microsporidiosis
Albendazole has been used in the treatment of microsporidiosis. Microsporidia can cause ocular infections (Encephalitozoon hellem, E. cuniculi, Vittaforma corneae), intestinal infections (Enterocytozoon bieneusi, Encephalitozoon intestinalis), and disseminated infections (E. hellem, E. cuniculi, E. intestinalis, Pleistophora, Trachipleistophora, Brachiola vesicularum). Intestinal infections are most common in immunocompromised patients, and are being reported with increasing frequency in patients with human immunodeficiency virus (HIV) infection. Some clinicians recommend use of albendazole in conjunction with fumagillin (not commercially available in the US) for the topical treatment of ocular microsporidiosis and also consider albendazole the drug of choice for intestinal infections caused by E. intestinalis and for disseminated microsporidiosis. Although some patients with intestinal microsporidiosis caused by E. intestinalis may respond to albendazole, the organism is not eradicated in all patients and recurrence of diarrhea is common after therapy is stopped. Patients with E. bieneusi infections generally do not respond to albendazole. Topical fumagillin therapy generally is not effective for ocular lesions caused by V. corneae, and keratoplasty may be necessary.
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.
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.
Amoxicillin : Precautions, Contraindications, pregnancy, lactation
Amoxicillin : Precautions, Contraindications, pregnancy, lactation
Amoxicillin shares the toxic potentials of the penicillins, including the risk of hypersensitivity reactions, and the usual precautions of penicillin therapy should be observed. Prior to initiation of therapy with amoxicillin, careful inquiry should be made concerning previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens. There is clinical and laboratory evidence of partial cross-allergenicity among penicillins and other -lactam antibiotics including cephalosporins and cephamycins. Amoxicillin is contraindicated in patients who are hypersensitive to any penicillin.
Because a high percentage of patients with infectious mononucleosis have developed rash during therapy with aminopenicillins, amoxicillin probably should not be used in patients with the disease.
Individuals with phenylketonuria (i.e., homozygous genetic deficiency of phenylalanine hydroxylase) and other individuals who must restrict their intake of phenylalanine should be warned that the amoxicillin 200- and 400-mg chewable tablets contain aspartame which is metabolized in the GI tract to provide 1.82 or 3.64 mg of phenylalanine, respectively, following oral administration. Amoxicillin powder for oral suspension does not contain aspartame.
Renal, hepatic, and hematologic systems should be evaluated periodically during prolonged therapy with amoxicillin.
Pregnancy
Safe use of amoxicillin during pregnancy has not been definitely established. There are no adequate or controlled studies using aminopenicillins in pregnant women, and amoxicillin should be used during pregnancy only when clearly needed. However, amoxicillin has been administered to pregnant women without evidence of adverse effects to the fetus. In addition, use of the drug is currently included in the US Centers For Disease Control and Prevention (CDC) recommendations for the treatment of chlamydial infections during pregnancy and CDC recommendations for the treatment of cutaneous anthrax or for postexposure prophylaxis following exposure to Bacillus anthracis spores.
Lactation
Because amoxicillin is distributed into milk and may lead to sensitization of infants, the drug should be used with caution in nursing women. Because of its general safety in infants, the CDC states that amoxicillin is an option for anti-infective prophylaxis in breast-feeding women when B. anthracis is known to be penicillin susceptible and there is no contraindication to maternal amoxicillin use.
Amoxicillin shares the toxic potentials of the penicillins, including the risk of hypersensitivity reactions, and the usual precautions of penicillin therapy should be observed. Prior to initiation of therapy with amoxicillin, careful inquiry should be made concerning previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens. There is clinical and laboratory evidence of partial cross-allergenicity among penicillins and other -lactam antibiotics including cephalosporins and cephamycins. Amoxicillin is contraindicated in patients who are hypersensitive to any penicillin.
Because a high percentage of patients with infectious mononucleosis have developed rash during therapy with aminopenicillins, amoxicillin probably should not be used in patients with the disease.
Individuals with phenylketonuria (i.e., homozygous genetic deficiency of phenylalanine hydroxylase) and other individuals who must restrict their intake of phenylalanine should be warned that the amoxicillin 200- and 400-mg chewable tablets contain aspartame which is metabolized in the GI tract to provide 1.82 or 3.64 mg of phenylalanine, respectively, following oral administration. Amoxicillin powder for oral suspension does not contain aspartame.
Renal, hepatic, and hematologic systems should be evaluated periodically during prolonged therapy with amoxicillin.
Pregnancy
Safe use of amoxicillin during pregnancy has not been definitely established. There are no adequate or controlled studies using aminopenicillins in pregnant women, and amoxicillin should be used during pregnancy only when clearly needed. However, amoxicillin has been administered to pregnant women without evidence of adverse effects to the fetus. In addition, use of the drug is currently included in the US Centers For Disease Control and Prevention (CDC) recommendations for the treatment of chlamydial infections during pregnancy and CDC recommendations for the treatment of cutaneous anthrax or for postexposure prophylaxis following exposure to Bacillus anthracis spores.
Lactation
Because amoxicillin is distributed into milk and may lead to sensitization of infants, the drug should be used with caution in nursing women. Because of its general safety in infants, the CDC states that amoxicillin is an option for anti-infective prophylaxis in breast-feeding women when B. anthracis is known to be penicillin susceptible and there is no contraindication to maternal amoxicillin use.
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