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Treatment

Praziquantel, adults, 5-10 mg/kg orally in a single-dose therapy. Praziquantel is not approved for treatment of children less than 4 years old but this drug has been used successfully to treat cases of D. caninum infection in children as young as 6 months.

Niclosamide is effective but is unvailable in the United States. No purge or follow-up stool examination is indicated, but appearance of proglottids after therapy is indication for retreatment. The infection is self-limiting in the human host and typically spontaneously clears by 6 weeks.

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.

References

  • Mackoviak PA. A Neonate with worms. Clin Infect Dis 2008;46:1145, 1786-88.
  • Samkari A, Kiska DL, Riddell SW et al. Dipylidium caninum mimicking recurrent Enterobius vermicularis (pinworm) infection. Clin Pediatr (Phila) 2008;47:397-9.
  • Molina C, Ogburn J, Adegboyega P. Infection by Dipylidium caninum in an infant. Arch Pathol Lab Med 2003;127:e157-9.

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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  • Page last updated: January 10, 2012
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