- The drug of choice for giardiasis in a first-term pregnant patient is paromomycin 25 to 35 mg/kg/day in divided doses for 5 to 10 days.
- Stool samples for amebiasis may not be ideal for differential diagnosis of species and the specific antigen test for definitive diagnosis of Entamoeba histolytica is the ELISA (Entamoeba histolytica II Kit) test.
- Asymptomatic cyst passers and patients with mild intestinal amebiasis should receive one of the following luminal agents: paromomycin 25 to 35 mg/kg/day three times daily for 7 days, iodoquinol 650 mg three times daily for 20 days, or diloxanide furoate 500 mg three times daily for 10 days.
- With the unavailability of pyrantel pamoate, either mebendazole (Vermox) or albendazole (Albenza) is the drug of choice for hookworm, ascariasis, enterobiasis, and trichuriasis.
- Administration of corticosteroids or other immunosuppressive drugs to an infected individual with strongyloidiasis can result in hyperinfections and disseminated strongyloidiasis.
- The most serious complication of cysticercosis is invasion of the CNS, which results in neurocysticercosis. Neurocysticercosis can cause obstructive hydrocephalus, strokes, and seizures; antihelminthic treatment for these conditions remains controversial.
- When IV quinidine is not readily available, IV artesunate (available under an investigational new drug (IND) from the CDC at http://wwwnc.cdc.gov/eid/article/17/5/10-1229_article.htm), a water-soluble artemisinin derivative, administered at 2.4 mg/kg/dose for 3 days at 0, 12, 24, 48, and 72 hours is the recommended drug if severe Plasmodium falciparum is suspected.
- Because falciparum malaria is associated with serious complications, including pulmonary edema, hypoglycemia, jaundice, renal failure, confusion, delirium, seizures, coma, and death, careful monitoring of fluid status and hemodynamic parameters is mandatory. Either hemofiltration or hemodiafiltration is indicated in renal failure.
- The two drugs that are available in the United States (obtained from CDC) to treat Trypanosoma cruzi infections are nifurtimox (Lampit) and benznidazole (Rochagan). Benznidazole is used as the drug of choice in South America.
- Permethrin (1% and 5%) for pediculosis and scabies, respectively, is the preferred agent and remains the safest agent, especially in infants and children. Spinosad crème rinse 0.9% and benzyl alcohol 5% are new agents for head lice.
On completion of the chapter, the reader will be able to:
Identify the drug of choice and treatment regimen for giardiasis in pregnant women.
Identify a specific test to differentiate Entamoeba histolytica from other nonpathogenic species in amebiasis.
Describe the drug regimen(s) for asymptomatic cyst passers in amebiasis.
List the drugs and regimen available for hookworm, ascariasis, and enterobiasis.
Evaluate the conditions that predispose a patient to disseminated strongyloidiasis.
Define the complication of cysticercosis and evaluate the role of antihelminthic drug therapy in neurocysticercosis.
Choose the drug of choice and identify the regimen in severe falciparum malaria when intravenous quinidine is not readily available.
Assess the complications of severe falciparum malaria and cite the monitoring parameters for this condition.
Describe the complications of American trypanosomiasis.
List the cardiovascular and neuropsychiatric adverse effects of mefloquine.
Define the complications of amebiasis and describe the drug regimen for hepatic amebiasis.
Evaluate the ...