Eficacia de la ivermectina en el tratamiento de niños colombianos parasitados por Strongyloides stercoralis.

Abstract

Se llevó a cabo un estudio para determinar la eficacia de 200 µg/kg diarios de ivermectina por 2 días en niños con estrongiloidiasis no complicada de un poblado de la Amazonia colombiana. Los criterios de inclusión fueron: ausencia de enfermedad aguda actual, sin ingestión de antiparasitarios en el último mes y sin presencia de trastornos hepáticos ni neurológicos severos; además, los participantes debían tener, al menos, 2 muestras positivas de 4 para Strongyloides stercoralis procesadas con la técnica de Baermann; este último criterio con el fin de disminuir la frecuencia de falsos negativos en los exámenes de seguimiento. De los 60 participantes que cumplieron estos requisitos, sólo 49 completaron, al menos, 4 muestras de seguimiento y fueron incluidos en los resultados. El porcentaje de curación contra S. stercoralis fue del 93,8% (46/49), con efectos secundarios leves y pasajeros. Se describen, además, los resultados contra otros parásitos intestinales. En conclusión, de acuerdo con la información disponible, la dosis diaria de ivermectina de 200 µg/kg por 2 días es el esquema terapéutico recomendado para la estrongiloidiasis no complicada en niños. Palabras clave: Strongyloides stercoralis, estrongiloidiasis, ivermectina, parásitos intestinales Efficacy of ivermectin in the treatment of children parasitized by Strongyloides stercoralisIn a small village of Amazonian Coombia, the efficacy of ivermectin (200 µg/kg/day) was determined in a two-day treatment of children with uncomplicated strongyloidiasis. Criteria for inclusion in the study were as follows: absence of acute disease, no pretreatment with antiparasitic drugs within the last month, absence of severe liver or neurological disorders, and at least 2 of 4 stool samples positive for Strongyloides stercoralis. The Baermann technique was used to detect larvae; it had the advantage of reducing the frequency of false negative results in the subsequent examinations. Of 60 potential subjects, 49 fulfilled the above criteria. The cure rate for the S. stercoralis infection was 94% (46/49), with slight and temporary side effects. The effects of ivermectin on other intestinal parasites were characterized as well. In conclusion, a 200 µg/kg/d ivermectin dose was an adequate therapeutic regimen in the treatment of uncomplicated strongyloidiasis in children.

Management of Chronic Strongyloidiasis in Immigrants and Refugees: Is Serologic Testing Useful?

“…However, recent literature suggests that two doses of ivermectin given 1-14 days apart has a cure rate of 94-100%. 11,[13][14][15][16][17] Thus, follow-up beyond 12 months may not be cost-effective.…”

“…Reported cure rates with ivermectin range from 94% to 100% after two doses administered 1-14 days apart. 11,[13][14][15][16][17] However, the most effective dosing regimen has not been determined. 18,19 A number of tests are currently used to detect infection with S. stercoralis , including stool testing and serologic analysis.…”

A systematic review and an individual patient data meta-analysis of ivermectin use in children weighing less than fifteen kilograms: Is it time to reconsider the current contraindication?

“…Three rounds of annual ivermectin and albendazole MDA in Argentina [53] and two rounds of annual ivermectin MDA in Australia [54] led to marked reduction on S. stercoralis prevalence. Strongyloidiasis can be life threatening in small children and ivermectin is a safe and effective cure for infected children weighing less than 15 kg [26,29,35,36,55].…”

Strongyloides stercoralislarvae excretion patterns before and after treatment

“…The efficacy of ivermectin in treating S. stercoralis has been demonstrated many times (Marti et al 1996; Toma et al 2000; Adenusi et al . 2003; Heukelbach et al 2004; Igual-Adell et al 2004; Ordonez and Angulo, 2004; Suputtamongkol et al 2011; Khieu et al 2013). However, little is known about the parasite clearance time and cessation of larvae excretion after ivermectin treatment (Uparanukraw et al 1999) in endemic settings.…”