Drugs for HELMINTHIC INFECTION

Helminths consist of various species of parasitic worms. Unlike the single celled
protozoa, helminthes have many cells, and thus their anatomy, physiology, and life cycle
are more complex.

Classification of Helminths
o Roundworms(nematodes)
o Flukes(trematodes)
o Tapeworm(cestodes)

Ascariasis
o Caused by the roundworm Ascariasis Lumbricoides
o The most common helminth disease worldwide affecting 1.4 billion people.The
parasite is endemic to latin America& Asia & 4 million American, generally in
the warm climates of the southeast, and in areas where hygiene and sanitation is
poor.
o Occur most commonly in children between age 3 to 8 years old, since this group
is mostly likely exposed to contaminated soil without proper handwashing
o Transmission of A. Lumbricoides occurs when a person accidentally ingest eggs
from the parasite. Once in the stomach, immature worm hatch from eggs, and
larvae attach to the intestinal wall. The larvae can travel through the vein and
lymphatics and be carried to the lungs, where they burrow through the alveolar
walls and migrate up to the bronchi. Once reaching the throat, the larvae are
swallowed and the cycle begins again.
o A. lumbricoides develops into an adult worm in the intestine.Female adult worm
lay as many as 240,000 eggs daily, which enter the feces.Under unsanitary
condition, ascaris eggs reach soil where they remain infective for years
o Ascariasis presents with both pulmonary and intestinal symptoms.
o Pulmonary symptoms As the larvae reach the lung, the patient experiences
cough, dyspnea, & low grade fever.
o The Intestinal phase is asymptomatic until large masses of worms are
present.
o Diagnosis is through identification of eggs or worms in the feces.Occasionally, a
worm is observed passing through the anus, mouth or nose.
o Oral Mebendazole(Vermox) for 3 days is the standard treatment. Stools are
rechecked 2 weeks after therapy. Albendazole & Pytanthel Pamoate are
alternative medication.

Enterobiasis
o Infection by pinworm Enterobius Vermicularis
o most common helminth infection in the United States
o The disease is caused by intense perineal itching due to the presence of deposited
Enterobius egg or migrating female worm. The itching is worse at night and may
cause restless, enuresis and insomia
 o Diagnosis is by identification of eggs on the perianal skin or worms in the stool.
o Transmission is by diapers, toys, hands, or food contaminated with the eggs.
o Treatment: Mebendazole, Albendazole or Pyranthel. Single dose is sufficient to
eradicate the pinworm, although the dose maybe repeated in 2 weeks to maximize
therapeutic success.

Hookworm.
o 2 Human hook worm: Ancylostoma duodenale & Necator Americanus.
o Mouth part of hookworm are modified cutting plates that cause hemorrhage when
worm attaches to the intestinal mucosa to suck blood from the host. Children are
particularly affected by the loss of blood . Although not directly fatal, hookworm
infection can weaken the body by causing anemia, may cause death from
infection by opportunistic infection.
o Transmission: when infective larva penetrates the skin, often by a child walking
barefoot through contaminated soil.
o Initial symptom of hook worm: itchy “ground rash” at the site of skin
penetration.As larvae migrate through the host’s blood, they travel the lung, and
up the throat where they are swallowed and eventually end up in the small
intestine).
o Pulmonary symptoms include cough, blood tinge sputum.
o Later symptoms include vague abdominal pain.
o Diagnosis: Infestation is confirmed by identification by hookworm eggs in the
feces.
o Larvae of dogs and cat hookworms can infect human, although they will not
mature into adult worm in the human host. Transmitted to humans through
contaminated soil or cat litter, these larvae remain in the skin where they migrate
for many weeks and cause intense itching. This result in a condition known as
Larva Migrans or “ Creeping eruption”- Thiabendazole is a treatment of choice.

Tapeworm.
o Beef tapeworm( Taenia Saginata) , grows 25 meters long. Pork tapeworm( Taenia
Solium) ,is 7 meters when raw or undercooked meat is eaten that contains cyst or
larvae of the parasite
o Transmission: Acquired when raw or undercooked meat is eaten that contains cyst
or larvae of the parasites.
o Treatment of Choice for most tapeworm infection is a single dose of Praziquantel.
For some infection, a laxative is given 2 hours after treatment. To remove all parts
of the worm and its eggs.

Drugs for Helminths Infection or Antihelminthics.

• Drugs use to treat worm infection are called antihelminthics
• Pharmacotherapy is not indicated for all helminthic infections because some are
self-limiting and the adult parasites die out without reinfecting the host.
 • When the infestation is severe or if complication is severe drug therapy is
initiated.
• Complication cause by extensive infestation may include physical obstruction in
the intestine, malabsorption, extensive loss of blood, increased risk for
opportunistic bacterial infections, and severe fatigue.

1.Mebendazole
o Mechanism of Action: Mebendazole kills helminths by Inhibition of glucose
transport and uncoupling energy metabolism in the parasite mitochondria
o Route: Per Oral (PO)
o Primary Metabolism: Hepatic
o Primary excretion: Feces
o Pregnancy: Category C
o Should be avoided during pregnancy, especially during the 1st trimester.
o Nursing Responsibility:
o Initiate infection control intervention to prevent spread of infection,
including meticulous handwashing. Because helminthic infection are often
result of poor sanitation or unhealthy hygiene habits
o Treat all family members simultaneously, because pinworms are
transmitted from person to person.
o Discontinue the Drug if monitoring reveals elevated hepatic
enzymes.Because the drug is metabolized in the liver

2. Albendazole- most common adverse effect: Abnormal liver function test).

3. Thiabendazole
4. Praziquantel- Drug of choice for schistosomiasis, a helminth infection cause by blood
flukes. People acquire the parasite by swimming in feces contaminated water.
5.Pyranthel Pamoate
6. Ivermectin- Drug of choice in treating Onchocerciasis or “river blindness”, a
debilitating filarial infection in Africa, the Middle East and Latin America.