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Treatment

Mebendazole*, is the drug of choice for adults, 200 mg orally twice a day for 20 days; the pediatric dosage is the same.

Alternative:

Albendazole*, adults, 400 mg orally once a day for 10 days; the pediatric dosage is the same.

(Note: Albendazole must be taken with food; a fatty meal increases oral bioavailability.)

Mebendazole

Oral mebendazole is available for human use in the United States

Note on Treatment in Pregnancy

Mebendazole is in pregnancy category C. Data on the use of mebendazole in pregnant women are limited. The available evidence suggests no difference in congenital anomalies in the children of women who were treated with mebendazole during mass treatment programs compared with those who were not. In mass treatment programs for which the World Health Organization (WHO) has determined that the benefit of treatment outweighs the risk, WHO allows use of mebendazole in the 2nd and 3rd trimesters of pregnancy. 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 mebendazole is excreted in breast milk. The WHO classifies mebendazole as compatible with breastfeeding and allows the use of mebendazole in lactating women.

Note on Treatment in Pediatric Patients

The safety of mebendazole in children has not been established. There is limited data in children age 2 years and younger. Mebendazole is listed as an intestinal antihelminthic medicine on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.

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.

*Not FDA-approved for this indication.

References

  • Li CD, Yang HL, Wang Y. Capillaria hepatica in China. World J Gastroenterol. 2010 Feb 14;16(6):698-702.
  • Drugs for Parasitic Infections. Treatment Guidelines from the Medical Letter. Vol 8 (Suppl), 2010. The Medical Letter, Inc., New Rochelle, NY.
  • Cañete R, Escobedo AA, Almirall P, González ME, Brito K, Cimerman S. Mebendazole in parasitic infections other than those caused by soil-transmitted helminths. Trans R Soc Trop Med Hyg 2009;103:437-42.
  • Moore TA. Agents active against parasites and pneumocystis , Table 44-1-General recommendations for the treatment of parasitic infections. In: Mandell GL, Bennett JE, Dolin R, Eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th Ed, Churchill Livingston/Elsevier, Philadelphia, PA, 2009.
  • Soukhathammavong P, Sayasone S, Harimanana AN et al. Three cases of intestinal capillariasis in Lao People's Democratic Republic. Am J Trop Med Hyg 2008;Nov;79(5):735-8.
  • Guerrant RL, Walker DH, Weller PF (eds). Tropical Infectious Diseases: Principles, Pathogens, and Practice, 2nd Edition. Philidelphia 2006, pp 1242-1244.
  • Bair MJ, Hwang KP, Wang TE et al. Clinical features of human intestinal capillariasis in Taiwan. World J Gastroenterol 2004 Aug 15;10(16):2391-3.

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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