Recommendations
| Dosage | Remarks | |
|---|---|---|
|
albendazole oral 400mg 2 times daily for 10 to 15 days
|
1st choice + prednisolone 1 mg/kg body weight for 7 days, then taper over one week |
|
|
mebendazole oral 200mg 3 times daily for 3 days
followed by mebendazole oral 400mg 3 times daily for 10 days |
2nd choice + prednisolone 1 mg/kg body weight for 7 days, then taper over one week |
Treatment with anthelmintics is only useful in the acute phase.
The pathogenesis can be divided into three phases:
1. Enteral or intestinal phase (incubation phase). The infection mainly presents as a type of food poisoning.
2. Parenteral or migratory phase (acute phase)
Clinical manifestations are due to release of toxic and allergenic substances into the bloodstream.
3. Muscle tissue phase (chronic phase)
The larvae encyst in the striated muscles. Aim of therapy: to reduce the number of adult worms. The diagnosis is usually made too late, by which time the adult worms have left the intestine.
Anthelmintics are active against adult worms and intestinal larvae (the first 2 weeks after infection). The benefit of anthelmintics for the larval stage in muscle is not proven.
In severe infection, or when the heart or brain are involved, or to suppress allergic manifestations, corticosteroids (prednisolone or prednisone) should be given, but always in combination with an anthelmintic.
Use of albendazole in pregnancy and breastfeeding: probably safe during pregnancy (2nd and 3rd trimesters) and breastfeeding
Albendazole is licensed for children from 6 years of age. In children between 1 and 6 years albendazole has been widely used worldwide and may be considered (Keijzer et al). Take albendazole with a fatty meal (increased absorption).
Notifiable disease group C.