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| __NOTOC__ | | __NOTOC__ |
| {{Ascariasis}} | | {{Ascariasis}} |
| {{CMG}}; '''Associate Editor-In-Chief:''' Imtiaz Ahmed Wani, [[M.B.B.S]] | | {{CMG}}{{AE}}{{FB}} |
| ==Overview== | | ==Overview== |
| ==Medical Therapy== | | ==Medical Therapy== |
| Pharmaceutical treatments include:
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| * [[Mebendazole]] (Vermox) (C<sub>16</sub>H<sub>13</sub>N<sub>3</sub>O<sub>2</sub>). Causes slow immobilization and death of the worms by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where helminths dwell. Oral dosage is 100 [[milligram|mg]] 12 hourly for 3 days.
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| * [[Piperazine]] (C<sub>4</sub>H<sub>10</sub>N<sub>2</sub>.C<sub>6</sub>H<sub>10</sub>O<sub>4</sub>). A flaccid paralyzing agent that causes a blocking response of ascaris muscle to acetylcholine. The narcotizing effect immobilizes the worm, which prevents migration when treatment is accomplished with weak drugs such as thiabendazole. If used by itself it causes the worm to be passed out in the feces. Dosage is 75 mg/kg (max 3.5 g) as a single oral dose.
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| * [[Pyrantel pamoate]] (Antiminth, Pin-Rid, Pin-X) (C<sub>11</sub>H<sub>14</sub>N<sub>2</sub>S.C<sub>23</sub>H<sub>16</sub>O<sub>6</sub>) Depolarizes ganglionic block of nicotinic neuromuscular transmission, resulting in spastic paralysis of the worm. Spastic (tetanic) paralyzing agents, in particular pyrantel pamoate, may induce complete intestinal obstruction in a heavy worm load. Dosage is 11 mg/kg not to exceed 1 g as a single dose.
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| * [[Albendazole]] (C<sub>12</sub>H<sub>15</sub>N<sub>3</sub>O<sub>2</sub>S) A broad-spectrum antihelminthic agent that decreases [[Adenosine triphosphate|ATP]] production in the worm, causing energy depletion, immobilization, and finally death. Dosage is 400 mg given as single oral dose (contraindicated during pregnancy and children under 2 years).
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| * [[Thiabendazole]]. This may cause migration of the worm into the [[esophagus]], so it is usually combined with piperazine.
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| * [[Hexylresorcinol]] effective in single dose, mentioned in : Holt, Jr Emmett L, McIntosh Rustin: Holt's Diseases of Infancy and Childhood: A Textbook for the Use of Students and Practitioners. Appleton and Co, New York,11th edition
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| * [[Santonin]], more toxic than [[hexylresorcinol]], mentioned in : Holt, Jr Emmett L, McIntosh Rustin: Holt's Diseases of Infancy and Childhood: A Textbook for the Use of Students and Practitioners. Appleton and Co, New York,, 11th edition
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| * Oil of ''Chenopodium'', more toxic than [[hexylresorcinol]], mentioned in : Holt, Jr Emmett L, McIntosh Rustin: Holt's Diseases of Infancy and Childhood: A Textbook for the Use of Students and Practitioners. Appleton and Co, New York, 11th edition
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| Also, [[corticosteroids]] can treat some of the symptoms, such as inflammation.
| | ===Antimicrobial Regimen for Ascariasis<ref name="Principles and Practice">Durand, Marlene (2015). "Chapter 288:Intestinal Nematodes (Roundworms)". Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition. Elsevier. pp. 3199–3207. ISBN 978-1-4557-4801-3.</ref><ref name="pmid9580117">{{cite journal| author=Romero Cabello R, Guerrero LR, Muñóz García MR, Geyne Cruz A| title=Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico. | journal=Trans R Soc Trop Med Hyg | year= 1997 | volume= 91 | issue= 6 | pages= 701-3 | pmid=9580117 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9580117 }} </ref><ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040 }} </ref>=== |
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| Native Americans have traditionally used [[epazote]] (''Chenopodium ambrisioides'') for treatment, which was not as powerful as pharmaceutical compounds, but spontaneous passage of Ascarids provided some proof of efficacy.
| | * Preferred regimen (1): [[Albendazole]] 400 mg PO single dose. [[Albendazole]] dose for children between the ages of 1-2 years is 200 mg. |
| | | * Preferred regimen (2): [[Mebendazole]] 500 mg PO single dose or 100 mg bid for 3 days |
| Some recent studies exist in the medical literature suggesting that sun-dried [[papaya]] and watermelon seeds may reduce infections by a large factor. The adult dosage is one tablespoon of the seed powder in a glass of [[sugar]] water once a week for two weeks. The sugar makes the bitter taste palatable and acts as a [[laxative]].
| | * Alternative regimen (1): [[Ivermectin]] 150 to 200 µg/kg PO single dose<ref>{{Cite web | title = Parasites - Ascariasis| url = http://www.cdc.gov/parasites/ascariasis/health_professionals/}}</ref> |
| | | * Alternative regimen (2): [[Nitazoxanide]] 500 mg bid for 3 days |
| ===Antimicrobial Regimen===
| | * Alternative regimen (3): [[Levamisole]] 150 mg PO single dose. The pediatric dose is 2.5 mg/kg |
| *Ascariasis
| | * Alternative regimen (4): [[Pyrantel]] Pamoate 11 mg/kg single dose PO - maximum 1.0 g |
| ::* Preferred regimen (1): [[Albendazole]] 400 mg PO single dose<ref>{{Cite web | title = Parasites - Ascariasis| url = http://www.cdc.gov/parasites/ascariasis/health_professionals/}}</ref>
| | * Alternative regimen (5): [[Piperazine citrate]] 75 mg/kg qd for 2 days - maximum 3.5 g |
| ::* Preferred regimen (2): [[Mebendazole]] 500 mg PO single dose or 100 mg bid for 3 days<ref>{{Cite web | title = Parasites - Ascariasis| url = http://www.cdc.gov/parasites/ascariasis/health_professionals/}}</ref>
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| :::*Note: [[Albendazole]] dose for children of 1-2 years is 200 mg instead of 400 mg.
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| ::* Alternative regimen (1): [[Ivermectin]] 150 to 200 µg/kg PO single dose<ref>{{Cite web | title = Parasites - Ascariasis| url = http://www.cdc.gov/parasites/ascariasis/health_professionals/}}</ref>
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| ::* Alternative regimen (2): [[Nitazoxanide]] 500 mg bid for 3 days <ref name="pmid9580117">{{cite journal| author=Romero Cabello R, Guerrero LR, Muñóz García MR, Geyne Cruz A| title=Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico. | journal=Trans R Soc Trop Med Hyg | year= 1997 | volume= 91 | issue= 6 | pages= 701-3 | pmid=9580117 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9580117 }} </ref>
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| ::* Alternative regimen (3): [[Levamisole]] 150 mg PO single dose
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| :::*Note: Pediatric dose: 2.5 mg/kg<ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040 }} </ref>
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| ::* Alternative regimen (4): [[Pyrantel]] Pamoate 11 mg/kg single dose PO - maximum 1.0 g<ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040 }} </ref>
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| ::* Alternative regimen (5): [[Piperazine citrate]] 75 mg/kg qd for 2 days - maximum 3.5 g<ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040 }} </ref>
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| ==References== | | ==References== |