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Antihelminthic drugs have diverse chemical structures, mechanisms of action, and properties. Most were discovered by empiric screening methods. Many act against specific parasites, and few are devoid of significant toxicity to host cells. In addition to the direct toxicity of the drugs, reactions to dead and dying parasites may cause serious toxicity in patients. In the text that follows, the drugs are divided into 3 groups on the basis of the type of helminth primarily affected (nematodes, trematodes, and cestodes). The drugs of choice and alternative agents for selected important helminthic infections are listed in Table 53–1.


TABLE 53–1Drugs for the treatment of helminthic infections.


The medically important intestinal nematodes responsive to drug therapy include Enterobius vermicularis (pinworm), Trichuris trichiura (whipworm), Ascaris lumbricoides (roundworm), Ancyclostoma and Necator species (hookworms), and Strongyloides stercoralis (threadworm). More than 1 billion persons worldwide are estimated to be infected by intestinal nematodes. Pinworm infections are common throughout the United States, and hookworm and threadworm are endemic in the southern United States. Tissue nematodes responsive to drug therapy include Ancyclostoma species, which cause cutaneous larva migrans. Species of Dracunculus, Onchocerca, Toxocara, and Wuchereria bancrofti (the cause of filariasis) are responsive to drug treatment. The number of persons worldwide estimated to be infected by tissue nematodes exceeds 0.5 billion.

A. Albendazole

1. Mechanisms

The action of albendazole is thought to involve inhibition of microtubule assembly. The drug is larvicidal in ascariasis, cystercercosis, hookworm, and hydatid disease and is ovicidal in ascariasis, ancyclostomiasis, and trichuriasis.

2. Clinical use

Albendazole has a wide ...

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