Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection

Abstract

Background Strongyloidiasis is a gut infection with Strongyloides stercoralis which is common world wide. Chronic infection usually causes a skin rash, vomiting, diarrhoea or constipation, and respiratory problems, and it can be fatal in people with immune deficiency. It may be treated with ivermectin or albendazole or thiabendazole. Objectives To assess the effects of ivermectin versus benzimidazoles (albendazole and thiabendazole) for treating chronic strongyloides infection. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (24 August 2015); the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE (January 1966 to August 2015); EMBASE (January 1980 to August 2015); LILACS (August 2015); and reference lists of articles. We also searched the meta Register of Controlled Trials ( m RCT) using 'strongyloid*' as a search term, reference lists, and conference abstracts. Selection criteria Randomized controlled trials of ivermectin versus albendazole or thiabendazole for treating chronic strongyloides infection. Data collection and analysis Two review authors independently extracted data and assessed risk of bias in the included trials. We used risk ratios (RRs) with 95% confidence intervals (CIs) and fixed‐ or random‐effects models. We pooled adverse event data if the trials were sufficiently similar in their adverse event definitions. Main results We included seven trials, enrolling 1147 participants, conducted between 1994 and 2011 in different locations (Africa, Southeast Asia, America and Europe). In trials comparing ivermectin with albendazole, parasitological cure was higher with ivermectin (RR 1.79, 95% CI 1.55 to 2.08; 478 participants, four trials, moderate quality evidence ). There were no statistically significant differences in adverse events (RR 0.80, 95% CI 0.59 to 1.09; 518 participants, four trials, low quality evidence ). In trials comparing ivermectin with thiabendazole, there was little or no difference in parasitological cure (RR 1.07, 95% CI 0.96 to 1.20; 467 participants, three trials, low quality evidence ). However, adverse events were less common with ivermectin (RR 0.31, 95% CI 0.20 to 0.50; 507 participants; three trials, moderate quality evidence ). In trials comparing different dosages of ivermectin, taking a second dose of 200 μg/kg of ivermectin was not associated with higher cure in a small subgroup of participants (RR 1.02, 95% CI 0.94 to 1.11; 94 participants, two trials). Dizziness, nausea, and disorientation were commonly reported in all drug groups. There were no reports of serious adverse events or dea...

Strongyloides stercoralis infection in human immunodeficiency virus‐infected patients and related risk factors: A systematic review and meta‐analysis

“…Our analysis revealed a significant proportion of S. stercoralis ‐positive cases within HIV + patients (5.1%). Immunocompromised people are the most at risk population for developing fatal illnesses including strongyloidiasis (Henriquez‐Camacho et al, ). Despite variable strength of association, HIV‐infected individuals are more likely to acquire S. stercoralis infections (Schär et al, ).…”

Question 1: Is it safe to use ivermectin in children less than five years of age and weighing less than 15 kg?

“…It is registered for use in scabies34–37 and is also an effective treatment for strongyloidiasis38 and head lice 39 40. Despite the burden of these diseases being in young children, the safety of oral ivermectin in children weighing less than 15 kg and aged less than 5 years has not been established and is therefore not recommended 41.…”

Strongyloides stercoralis is associated with significant morbidity in rural Cambodia, including stunting in children

“…stercoralis using a single oral dose of ivermectin (200 μg / kg body weight (BW)), which achieves high cure rates, comparable to that of a two dose regimen [11–16]. …”