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Treatment

Praziquantel, adults and children, 25mg/kg in a single-dose therapy.

Alternatives:

Niclosamide*: adults, 2 gm in a single dose for 7 days; children 11-34 kg, 1 gm in a single dose on day 1 then 500 mg per day orally for 6 days; children > 34 kg, 1.5 gm in a single dose on day 1 then 1 gm per day orally for 6 days.

Nitazoxanide: adults, 500 mg orally twice daily for 3 days; children aged 12-47 months, 100 mg orally twice daily for 3 days; children 4-11 years, 200 mg orally twice daily for 3 days.

*Niclosamide is unavailable in the United States.

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.

Nitazoxanide

Nitazoxanide is available for human use in the United States.

Note on Treatment in Pregnancy

Nitazoxanide is in pregnancy category B. Data on the use of nitazoxanide in pregnant women are limited, and risk to the embryo-fetus is unknown. Nitazoxanide 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 nitazoxanide is excreted in breast milk. Nitazoxanide should be used with caution in breastfeeding women.

Note on Treatment in Pediatric Patients

Nitazoxanide tablets should not be used in children age 11 years or younger as a single tablet contains a greater dose than recommended for pediatric dosing. Nitazoxanide oral suspension may be used for dosing in children, although the safety in children age 1 and younger is not certain.

References

  • Chero JC, Saito M, Bustos JA. Hymenolepis infection: symptoms and response to nitazoxanide in field conditions. Trans R Soc Trop Med Hyg 2007;101(2):203-5.
  • Craig P, Ito A. Intestinal cestodes. Curr Opin Infect Dis 2007;20:524-32.
  • Fox LM, Saravolatz LD. Nitazoxanide: A New Thiazolide Antiparasitic Agent. Clin Infect Dis 2005;40:1173-80.
  • Ortiz JJ, Lopez Chegne N, Gargala G, Favennec L. Comparative clinical studies of nitazoxanide, albendazole and praziquantel in the treatment of ascariasis, trichuriasis and hymenolepiasis in children from Peru. Trans R Soc Trop Med Hyg 2002;96:193-6.
  • Jones WE. Niclosamide as a treatment for Hymenolepis diminuta and Dipylidium caninum infection in man. Am J Trop Med Hyg 1979:28(2):300-02.
  • Romero Cabello R, Guerrero LR, Munoz Garcia M, Geyne Cruz A. Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico. Trans R Soc Trop Med Hyg1997:91:701-3.
 
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