Jessica Barrett1, Claire Broderick2, Hannah Soulsby3, Paul Wade3, William Newsholme3. 1. Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK jessica.barrett@gstt.nhs.uk. 2. Department of Infectious Diseases, University College Hospital, 235 Euston Road, London NW1 2BU, UK. 3. Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
Abstract
BACKGROUND: Strongyloides stercoralis infection presents with varying degrees of severity, but it often primarily involves the small bowel. In severe infection and cases of hyperinfection, ileus and small-bowel obstruction may prevent enteral absorption of anthelminthics such as ivermectin. At present there are no parenteral anthelminthics licensed for use in humans. METHODS: Here, we describe two cases of severe S. stercoralis infection treated with an unlicensed veterinary preparation of subcutaneous ivermectin, and we discuss the published reports of the use of this treatment elsewhere. RESULTS: Both patients were successfully treated with subcutaneous ivermectin, and both recovered completely. CONCLUSIONS: Despite the limited published experience of parenteral ivermectin use, there is evidence that it may be a safe and effective treatment for severe strongyloidiasis. However, more data are needed to guide dosing schedules and monitoring for toxicity.
BACKGROUND:Strongyloides stercoralis infection presents with varying degrees of severity, but it often primarily involves the small bowel. In severe infection and cases of hyperinfection, ileus and small-bowel obstruction may prevent enteral absorption of anthelminthics such as ivermectin. At present there are no parenteral anthelminthics licensed for use in humans. METHODS: Here, we describe two cases of severe S. stercoralisinfection treated with an unlicensed veterinary preparation of subcutaneous ivermectin, and we discuss the published reports of the use of this treatment elsewhere. RESULTS: Both patients were successfully treated with subcutaneous ivermectin, and both recovered completely. CONCLUSIONS: Despite the limited published experience of parenteral ivermectin use, there is evidence that it may be a safe and effective treatment for severe strongyloidiasis. However, more data are needed to guide dosing schedules and monitoring for toxicity.
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