Drug of choice of Strongyloides stercoralis
Ans. c (Ivermectin) (Ref. Nelson paediatrics 18th, Table 276-1; Harrison's Internal Medicine 17th ed., Ch. el7)Nematodes (roundworms)TransmissionDiseaseRxStrongyloides stercoralisLarvae in soil penetrate the skinintestinal infection causing vomiting, diarrhea, epigastric pain (may be peptic ulcer- like)Ivermectin or albendazoleIVERMECTIN# Ivermectin is a derivative of the macrocyclic lactone avermectin produced by the soil-dwelling actinomycete Streptomyces avermitilis.# Recent data suggest that ivermectin acts by opening the neuromuscular membrane-associated, glutamate-dependent chloride channels. The influx of chloride ions results in hyperpolarization and muscle paralysis--particularly of the nematode pharynx, with consequent blockage of the oral ingestion of nutrients.# Ivermectin is available only as an oral formulation.# The drug is highly protein bound; it is almost completely excreted in feces.# The effect of food on bioavailability is unknown. Ivermectin is distributed widely throughout the body.# Ivermectin is generally administered as a single dose of 150-200 pg/kg.# Ivermectin is the drug of choice for the treatment of -- Strongyloidiasis,- Onchocerciasis,.....SOCS = Mneumonic- Cutaneous larva migrans,- Scabies.# Ivermectin is highly active against microfilariae of the lymphatic filariases but has no macrofllaricidal activity.# When ivermectin is used in combination with other agents such as DEC or albendazole for treatment of lymphatic filariasis, synergistic activity is seen.# While active against the intestinal helminths Ascaris lumbricoides and Enterobius vermicularis, ivermectin is only variably effective in trichuriasis and is ineffective against hookworms.# Adverse effects- In patients with filarial infections include fever, myalgia, malaise, lightheadednes,postural hypotension.- More severe complications of ivermectin therapy for onchocerciasis include encephalopathy in patients heavily infected with Loa loa. This reaction has led to the suspension of ivermectin distribution for this indication in regions where the two filarial infections are coendemic.- Ivermectin although is the first-line agent for the treatment of onchocerciasis, in areas of Africa co-endemic for O. volvulus and L. loa, however, ivermectin is contraindicated (as it is for pregnant or breast-feeding women) because of severe posttreatment encephalopathy.
Albendazole
Mebendazole
Ivermectin
Pyrantel pamoate
Infection