C H A P T E R 1 3
Anthelmintic agents
183
ANTHELMINTICS
The anthelmintic drugs (see Table 13.2) act on meta
bolic pathways that are present in the invading
worm but are absent or significantly different in the
human host. Anthelmintic drugs include albendazole
(
Eskazole
,
Zentel
), ivermectin (
Stromectol
), meben-
dazole (
Ridworm, Vermox
), praziquantel (
Biltricide
)
and pyrantel (
Anthel,
Combantrin
). Box 13.2 includes
information about use of these drugs across the lifespan.
See the Critical thinking scenario for a case study of a
person receiving anthelmintics.
TABLE 13.2
DRUGS IN FOCUS Anthelmintics
Drug name
Dosage/route
Usual indications
albendazole (Eskazole,
Zentel)
Hydatid disease:
≥60 kg: 400 mg b.d. PO
<60 kg: 15 mg/kg per day PO in divided
doses, b.d., on a 28-day cycle, followed by
14 days of rest, for a total of three cycles
Neurocysticercosis:
≥60 kg: 400 mg b.d. PO
<60 kg: 15/mg/kg per day PO in divided
doses, b.d., for 8–30 days of treatment
Treatment of active lesions caused by pork
tapeworm and cystic disease of the liver,
lungs and peritoneum caused by dog
tapeworm
ivermectin (Stromectol)
150–200 mcg/kg PO as a single dose
Treatment of threadworm disease or
strongyloidiasis; onchocerciasis or river
blindness, which is found in tropical areas
of Africa, Mexico and South America
mebendazole
(Ridworm, Vermox)
100 mg PO morning and evening on three
consecutive days
Enterobiasis:
100 mg PO as a single dose
Treatment of diseases caused by
pinworms, roundworms, whipworms
and hookworms
praziquantel (Biltricide)
Three doses of 20–25 mg/kg PO as a 1-day
treatment
Treatment of a wide number of
schistosomes or flukes
pyrantel (Anthel,
Combantrin)
10 mg/kg PO as a single dose; maximum dose,
1 g
Treatment of diseases caused by
pinworms and roundworms; because
administered in single dose, may be
preferred for people who could have
trouble remembering to take medication
or following drug regimens
BOX 13.2
Drug therapy across the lifespan
Anthelmintic agents
CHILDREN
Culture of the suspected worm is important before
beginning any drug therapy.
The more toxic drugs—albendazole, ivermectin and
praziquantel—should be avoided in children.
The most commonly used anthelmintic, mebendazole,
comes in a chewable tablet that is convenient for use in
children.
Nutritional status and hydration are major concerns
with children taking these drugs who develop serious
gastrointestinal effects.
ADULTS
Adults may be somewhat repulsed by the idea that they
have a worm infestation, and they may be reluctant to
discuss the needed lifestyle adjustments and treatment
plans.
PREGNANCY AND BREASTFEEDING
Pregnant and breastfeeding women should not use
these drugs unless the benefit clearly outweighs the
potential risk to the fetus or neonate. If a severe helminth
infestation threatens the mother, some of the drugs can
be used as long as the mother is informed of the potential
risk.
OLDER ADULTS
Older people may be more susceptible to the central
nervous system and gastrointestinal effects of some
of these drugs. Dose adjustment is needed for these
agents.
Monitor hydration and nutritional status carefully.
