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Snapshot
  • A 30-year-old man presents to the urgent care clinic for fevers, a skin rash, and a cough. He reports that he had traveled to Japan last week. He had walked around the coastline barefoot and ate many meals of raw fish. He also reports having some unexpected weight loss and loss of appetite. On exam, he has edematous pink plaques consistent with urticaria. Basic laboratory evaluation is largely normal with the exception of elevated eosinophil levels. He is suspected of having Katayama fever and a stool exam is ordered, revealing eggs with a lateral spine. He is started on praziquantel. (Schistosoma japonicum infection)
Introduction
  • Drugs
    • pyrantel pamoate
    • ivermectin
    • mebendazole
    • praziquantel
    • diethylcarbamazine
    • niridazole
  • Clinical use
    • helminths
      • cestodes (tapeworms) 
      • trematodes (flukes) 
      • nematodes (roundworms) 
 
Anti-Helminth Medications
Drug Mechanism of Action
Adverse Effects
Helminth
Pyrantel pamoate
  • Neuromuscular blocking agent, causing depolarization
  • Gastrointestinal upset
  • Headaches
  • Nematodes
    • Enterobius
    • Ancylostoma
    • Necator
Ivermectin
  • Binds to glutamate-gated chloride channels, causing hyperpolarization
  • Skin pruritus
  • Nematodes
    • Onchocerca (Rivermectin)
    • Strongyloides
Bendazole
  • Inhibits tubulin polymerization, interfering with microtubule formation
  • Gastrointestinal upset
  • Stevens-Johnson syndrome
  • Mebendazole
    •  nematodes
      • Enterobius
      • Ascaris
      • Toxocara
      • Trichuris
      • Trichinella
      • Strongyloides
      • Ancylostoma
      • Necator
  • Albendazole
    • cestodes
      • Taenia
      • Echinococcus
Praziquantel
  • Unknown, may interfere with cell membrane permeability and cause paralysis in the helminth
  • Gastrointestinal upset
  • Dizziness
  • Cestodes
    • Taenia
    • Diphyllobothrium
  • Trematodes
    • Schistosoma
    • Clonorchis
    • Paragonimus
Diethylcarbamazine
  • Inhibits arachidonic acid metabolism, making the helminth more susceptible to the host's innate immune system
  • Skin pruritus
  • Facial swelling
  • Headaches
  • Nematodes
    • Wucheria
    • Loa loa
Niridazole
  • Inhibits oogenesis and spermatogenesis
  • Central nervous system toxicity
  • Nematode
    • Dracunculus

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