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Neurocysticercosis

  • Neurocysticercosis treatment (NCC)[1]
  • 1. Larval form of Taenia solium
  • Preferred regimen: Praziquantel 5-10 mg/kg PO for single dose for children & adults.
  • 2. Parenchymal neurocysticercosis
  • 2.1 Patients body weight of ≥60 kg
  • Preferred regimen: Albendazole 400 mg PO bid AND Dexamethasone 0.1 mg/kg/day PO with or without anti-seizure medication all for 8-30 days
  • 2.2 Patients body weight of 60 kg
  • Preferred regimen: Albendazole 15 mg/kg/day PO bid (max. 800 mg/day) AND Dexamethasone 0.1 mg/kg/day PO with or without anti-seizure medication] all for 8-30 days
  • Alternative regimen: (Praziquantel 100 mg/kg per day PO tid for 1 day, then 50 mg/kg/day tid AND Dexamethasone 0.1mg/kg per day with or without anti-seizure medication) all for 29 days.
  • Note (1): Albendazole associated with 46% decrease in seizures.
  • Note (2): Praziquantel less cysticidal activity.
  • Note (3): Steroids decrease serum levels of Praziquantel
  • Note (4): NIH reports Methotrexate at ”20 mg/wk allows a reduction in steroid use.
  • 3. Degenerating cysts
  • 3.1 Patients body weight of ≥60 kg
  • Preferred regimen: Albendazole 400 mg PO bid AND Dexamethasone 0.1 mg/kg/day PO with or without anti-seizure medication all for 8-30 days
  • 3.2 Patients body weight of 60 kg
  • Preferred regimen: Albendazole 15 mg/kg/day PO bid (max. 800 mg/day) AND Dexamethasone 0.1 mg/kg/day PO with or without anti-seizure medication] all for 8-30 days
  • Alternative regimen: (Praziquantel 100 mg/kg per day PO tid for 1 day, then 50 mg/kg/day tid AND Dexamethasone 0.1mg/kg/day PO with or without anti-seizure medication) all for 29 days.
  • Note (1): Treatment improves prognosis of associated seizures.
  • Note (2): For dead calcified cysts, no treatment indicated
  • 4. Subarachnoid neurocysticercosis
  • 4.1 Patients body weight of ≥60 kg
  • Preferred regimen: Albendazole 400 mg PO bid AND Dexamethasone 0.1 mg/kg/day PO with or without anti-seizure medication all for 8-30 days
  • 4.2 Patients body weight of 60 kg
  • Preferred regimen: Albendazole 15 mg/kg/day PO bid (max. 800 mg/day) AND Dexamethasone 0.1 mg/kg/day PO with or without anti-seizure medication] all for 8-30 days
  • Alternative regimen: (Praziquantel 100 mg/kg per day PO tid for 1 day, then 50 mg/kg/day tid AND Dexamethasone 0.1mg/kg/day PO with or without anti-seizure medication) all for 29 days.
  • Note: Shunting for hydrocephalus, as without shunt, 50% of patients died within 9 years.
  • 5. Intraventricular neurocysticercosis
  • 5.1 Patients body weight of ≥60 kg
  • Preferred regimen: Albendazole 400 mg PO bid AND Dexamethasone 0.1 mg/kg/day PO with or without anti-seizure medication all for 8-30 days
  • 5.2 Patients body weight of 60 kg
  • Preferred regimen: Albendazole 15 mg/kg/day PO bid (max. 800 mg/day) AND Dexamethasone 0.1 mg/kg/day PO with or without anti-seizure medication] all for 8-30 days
  • Alternative regimen: (Praziquantel 100 mg/kg per day PO tid for 1 day, then 50 mg/kg/day tid AND Dexamethasone 0.1mg/kg/day PO with or without anti-seizure medication) all for 29 days
  • Note: Neuroendoscopic removal if obstruction of CSF circulation.

Parasites – Ectoparasites

  • Body lice
  • Pediculus humanus, corporis treatment[2]
  • A body lice infestation is treated by improving the personal hygiene of the infested person, including assuring a regular (at least weekly) change of clean clothes.
  • Clothing, bedding, and towels used by the infested person should be laundered using hot water (at least 130°F) and machine dried using the hot cycle.
  • Sometimes the infested person also is treated with a pediculicide Ivermectin Lotion; however, a pediculicide Ivermectin generally is not necessary if hygiene is maintained and items are laundered appropriately at least once a week. A pediculicide Ivermectin should be applied exactly as directed on the bottle or by your physician.
  • Head lice
  • Pediculus humanus, capitis treatment[3]
  • Preferred regimen (1): Permethrin 1% lotion apply to shampooed dried hair for 10 min.; repeat in 9-10 days
  • Preferred regimen (2): Malathion 0.5% lotion (Ovide) apply to dry hair for 8–12hrs, then shampoo. 2 doses 7-9 days apart
  • Alternative regimen: Ivermectin 200 μg/kg PO once; 3 doses at 7 day intervals reported effective.
  • Phthirus pubis treatment
  • Preferred regimen (1): Permethrin 1% cream rinse applied to affected areas and washed off after 10 minutes
  • Preferred regimen (2): Pyrethrins with piperonyl butoxide applied to the affected area and washed off after 10 minutes
  • Alternative regimen (1): Malathion 0.5% lotion applied to affected areas and washed off after 8–12 hours
  • Alternative regimen (2): Ivermectin 250 ug/kg PO, repeated in 2 weeks
  • Preferred regimen: No medications approved by the FDA are available for treatment[5]
  • Note: Fly larvae need to be surgically removed.
  • Fly larvae treatment [6]
  • Preferred treatment (1): Occlude punctum to prevent gas exchange with petrolatum, fingernail polish, makeup cream or bacon.
  • Preferred treatment (2): When larva migrates, manually remove.
  • Note (1): Myiasis is due to larvae of flies.
  • Note (2): Usually cutaneous/subcutaneous nodule with central punctum.
  • Scabies
  • Sarcoptes scabiei treatment [7]
  • 1. Immunocompetent patisent
  • Preferred regimen: (Primary) Permethrin 5% cream (ELIMITE).
Note (1): Apply entire skin from chin down to and including toes with Permethrin 5% cream. Leave on 8–14hours. Repeat if itching persists for >2-4 wks after treatment or new pustules occur.
Note (2): Safe for children >2 months old.
  • Alternative regimen: Ivermectin 200 μg/kg PO once. As above, second dose if persistent symptoms.
Note (1): Trim fingernails.
Note (2): Reapply to hands after hand washing.
Note (3): Pruritus may persist times 2 weeks after mites gone.
  • Alternative regimen (2): Less effective is Crotamiton 10% cream, apply for 24 hours, rinse off, then reapply for 24 hours.
  • 2. AIDS patients (CD4 <150 per mm3), debilitated or developmentally disabled patients
* preferred regimen (for Norwegian scabies) : Permethrin 5% cream-2 or more applications a week apart may be needed. After each Permethrin dose (days 2-7) apply 6% Sulfur in petrolatum.
Note: Apply entire skin from chin down to and including toes with Permethrin 5% cream. Leave on 8–14hours. Repeat if itching persists for >2-4 wks after treatment or new pustules occur.

Sparganosis

  • Sparganosis (Spirometra mansonoides) treatment [8]
  • Preferred treatment: Surgical resection or ethanol injection of subcutaneous masses
Note: Source for Spirometra mansonoides larval cysts is frogs or snakes
  1. ↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
  2. ↑ Template:CDC
  3. ↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
  4. ↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
  5. ↑ "Parasites - Myiasis".
  6. ↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
  7. ↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
  8. ↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
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