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Treatment

It is often possible to diagnose and treat gastric anisakiasis by removal of the worm using an endoscope. Diagnosis of enteric anisakiasis is more difficult; however, it can generally be managed without removal of the worm because the worm will eventually die. Surgery may be required for intestinal or extraintestinal infections when intestinal obstruction, appendicitis, or peritonitis occurs. Successful treatment of anisakiasis with albendazole* 400 mg orally twice daily for 6 to 21 days has been reported in cases with presumptive (highly suggestive history and/or serology) diagnoses.

*Not FDA-approved for this indication

Albendazole

Oral albendazole is available for human use in the United States.

Note on Treatment in Pregnancy

Albendazole is pregnancy category C. Data on the use of albendazole in pregnant women are limited, though the available evidence suggests no difference in congenital abnormalities in the children of women who were accidentally treated with albendazole during mass prevention campaigns compared with those who were not. In mass prevention campaigns for which the World Health Organization (WHO) has determined that the benefit of treatment outweighs the risk, WHO allows use of albendazole in the 2nd and 3rd trimesters of pregnancy. However, the risk of treatment in pregnant women who are known to have an infection needs to be balanced with the risk of disease progression in the absence of treatment.

Pregnancy Category C: Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal, or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus.

Note on Treatment During Lactation

It is not known whether albendazole is excreted in human milk. Albendazole should be used with caution in breastfeeding women.

Note on Treatment in Pediatric Patients

The safety of albendazole in children less than 6 years old is not certain. Studies of the use of albendazole in children as young as one year old suggest that its use is safe. According to WHO guidelines for mass prevention campaigns, albendazole can be used in children as young as 1 year old. Many children less than 6 years old have been treated in these campaigns with albendazole, albeit at a reduced dose.

References

  • Hochberg NS, Hamer DH. Anisakidosis: Perils of the deep. Clin Infect Dis 2010;51:806-12.
  • Yasunaga H, Horguichi H, Kuwabara K, Hashimoto H, Matsuda S. Clinical features of bowel anisakiasis in Japan. Am J Trop Med Hyg 2010;83:104-5.
  • Nakaji K. Enteric anisakiasis which improved with conservative treatment. Intern Med 2009;48:573.
  • Pacios E, Arias-Diaz J, Zuloaga J, Gonzalez-Armengol J, Villarroel P, Balibrea JL. Albendazole for the treatment of anisakiasis ileus. Clin Infect Dis 2005;41:1825-6.
  • Repiso Ortega A, Alcántara Torres M, González de Frutos C, de Artaza Varasa T, Rodríguez Merlo R, Valle Muñoz J, Martínez Potenciano JL. Gastrointestinal anisakiasis. Study of a series of 25 patients (Spanish). Gastroenterol Hepatol 2003;26:341-6.
  • Moore DA, Girdwood RW, Chiodini PL. Treatment of anisakiasis with albendazole. Lancet 2002;360(9326):54.
  • Matsui T, Iida M, Murakami M, Kimura Y, Fujishima M, Yao Y, Tsuji M. Intestinal anisakiasis: clinical and radiologic features. Radiology 1985;157:299-302.

This information is provided as an informational resource for licensed health care providers as guidance only. It is not intended as a substitute for professional judgment.

 
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