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Treatment

Praziquantel*, adults, 5-10 mg/kg orally in a single-dose therapy; the dosage for children is the same.

(Note: praziquantel should be taken with liquids during a meal.)

Alternative:

Adults, niclosamide 2 gm orally once; children, 50 mg/kg (max 2 gm) orally once.

(Note: niclosamide must be chewed thoroughly or crushed and swallowed with a small amount of water.)

Praziquantel

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

Note on Treatment in Pregnancy

Praziquantel is pregnancy category B. There are no adequate and well-controlled studies in pregnant women. However, the available evidence suggests no difference in adverse birth outcomes in the children of women who were accidentally treated with praziquantel 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 encourages the use of praziquantel in any stage of pregnancy. For individual patients in clinical settings, 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 B: Either animal-reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no evidence of a risk in later trimesters).

Note on Treatment During Lactation

Praziquantel is excreted in low concentrations in human milk. According to WHO guidelines for mass prevention campaigns, the use of praziquantel during lactation is encouraged. For individual patients in clinical settings, praziquantel should be used in breast-feeding women only when the risk to the infant is outweighed by the risk of disease progress in the mother in the absence of treatment.

Note on Treatment in Pediatric Patients

The safety of praziquantel in children aged less than 4 years has not been established. Many children younger than 4 years old have been treated without reported adverse effects in mass prevention campaigns and in studies of schistosomiasis. For individual patients in clinical settings, the risk of treatment of children younger than 4 years old who are known to have an infection needs to be balanced with the risk of disease progression in the absence of treatment.

Niclosamide

Niclosamide is NOT available for human use in the United States.

Note on Treatment in Pregnancy

Niclosamide is in pregnancy category B. Data on the use of niclosamide in pregnant women are limited. Niclosamide is not thought to be systemically absorbed. Niclosamide should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Pregnancy Category B: Either animal-reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no evidence of a risk in later trimesters).

Note on Treatment During Lactation

It is not known whether niclosamide is excreted in breast milk, although niclosamide is not thought to be systemically absorbed. The World Health Organization (WHO) classifies niclosamide as compatible with breastfeeding, although data on the use of niclosamide during lactation are limited.

Note on Treatment in Pediatric Patients

The safety of niclosamide in children has not been established, although niclosamide is not thought to be systemically absorbed. Available evidence suggests that the safety profiles are comparable in children 2 years or older and adults.

*Not FDA-approved for this indication.

References

  • Praziquantel. Cestode (Tapeworm) Infections. In: AHFS Drug Information, McEvoy GK, Ed., American Society of Health-System Pharmacists, Bethesda, MD , 2011.
  • Drugs for Parasitic Infections. Treatment Guidelines from the Medical Letter. Vol 8 (Suppl), 2010. The Medical Letter, Inc., New Rochelle, NY.
  • Scholz T, Garcia HH, Kuchta R, Wich B. Update on the human broad tapeworm (Genus Diphyllobothrium) including clinical relevance. Clin Microbiol Rev 2009;22:146-60.
  • Richards FO Jr. Diphyllobothrium species. In: Long SS, Pickering LK, Prober CG, Eds. Principals and Practices of Pediatric Infectious Diseases Revised Reprint, 3rd Ed, Churchill Livingston/Elsevier, Philadelphia, PA, 2009.
  • King CH, Fairley JK. Cestodes. 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.
  • Loukas A, Hotez PJ. Chemotherapy of helminth infections. In: Goodman & Gilman's The Pharmacological Basis of Therapeutics, 11th Ed. McGraw-Hill, NY, 2006.
  • Harter A. Milestones of helmintic research at Bayer. Parasitol Res 2002;88:477-80.
  • Ohnishi K, Murata M. Praziquantel for the treatment of Diphyllobothrium nihonkaiense infections in humans. Trans R Soc Trop Med Hyg 1994;88:580.

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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