Helminths which parasitise

humans
Trematodes or Flukes

 Blood flukes: Schistosoma haematobium, Schistosoma

mansoni, Schistosoma japonicum.

 Lung flukes: Paragonimus species.

 Hepatobiliary flukes: Clonorchis sinensis, Fasciola

hepatica.
 Intestinal flukes: Fasciolopsis buski, Heterophyes
heterophyes.
 Cestodes or Tapeworms

 Intestinal tapeworms (adult stages):

Taenia saginata, Taenia solium, Diphyllobothrium latum,
Dipylidium caninum, Hymenolepis nana.

 Tissue cysts or worms (larval stages):

Taenia solium (cysticercosis), Echinococcus granulosus (hydatid
disease), Multiceps multiceps (coenurus), Spirometra mansoni
(sparganosis).
 Nematodes or Round Worms

 Intestinal human nematodes:

Enterobuis vermicularis, Ascaris lumbricoides, Ancylostoma
duodenale, Necator americanus, Trichuris trichiura, Strongyloides
stercoralis.

 Tissue human nematodes:

Wuchereria bancrofti, Brugia malayi, Loa loa, Onchocerca volvulus
(all filarial worms); Dracunculus medinensis (guinea worm).

 Zoonotic nematodes:
Toxocara canis, Toxocara cati (causing visceral larva migrans),
Ancylostoma braziliense, Ancylostoma caninum (causing
cutaneous larva migrans), Trichinella spiralis.
 Trematode (Fluke) Infections
Dosage Drug Infection
40 mg/kg.b.w. as a single Praziquantel (Destocid) Schistosoma
oral dose, once. Nausea, vomiting, pruritis haematobium

7.5 mg/kg orally repeated Metrifonate(Bilharcil).

OPC has cholinergic symptoms
every 2 weeks for 3 doses. (abd. Colics, dry mouth, etc)

2 capsules (300 mg capsule) Mirazid

daily on empty stomach for 3
consecutive days.
As S.hematobium Praziquantel Schistosoma
As S.hematobium Mirazid mansoni

20 mg/kg orally, daily for 3 Oxamniquine (Vansil)

days. Dizziness, headache, vomiting
Orange red urine
Oxamniquine fever?
 Trematode (Fluke) Infections (cont.)
Dosage Drug Infection
25 mg/kg.b.w. three Praziquantel Paragonimus
times/day orally for 3 days. westermani
25 mg/kg.b.w. three Praziquantel Fasciola heptica
times/day orally for 3 days.

2 capsules (300 mg capsule) Mirazid

daily on empty stomach for 6
consecutive days.

10 mg/kg.b.w. as a single Triclabendazole (Fasinex)

dose which may be repeated.
25 mg/kg.b.w. three Praziquantel Clonorchis sinensis
times/day orally for 2 days.
 Trematode (Fluke) Infections (cont.)
Dosage Drug Infection
15 mg/kg.b.w. orally at bed Praziquantel Fasciolopsis buski
time, once.

25 mg/kg.b.w. 3 times/day Praziquantel Heterophyes

orally for three days. heterophyes
 Cestode (Tapeworm) Infections
Dosage Drug Infection
20 mg/kg.b.w. as a single Praziquantel (Destocid) Taenia saginata
oral dose. (beef tapeworm)
1 gm (2 tablets) chewed Niclosamide (Yomesan,
followed after 2 hours by Niclosan)
another 1 gm.
10mg/kg single oral dose Praziquantel Taenia solium
(pork tapeworm)
and cerebral
50 mg/kg/day t.d.s orally for Praziquantel cysticercosis
15 days.
15 mg/kg.b.w./day, orally in Albendazole
two doses for 8-30 days.
Steroids (to decrease
the surrounding reaction)
 Cestode (Tapeworm) Infections
Dosage Drug Infection
20 mg/kg.b.w. as a single Praziquantel Diphyllobothrium
oral dose. latum
(fish tapeworm)
Parentral vitamin B12
should be given if B12
deficiency is manifest.
20 mg/kg.b.w. as a single Praziquantel Dipylidium
oral dose. caninum
(dog tapeworm)

20 mg/kg.b.w. as a single Praziquantel Hymenolepis nana

oral dose (Dwarf tapeworm)
Traetment should be
repeated one week later
 Cestode (Tapeworm) Infections (cont.)

Dosage Drug Infection

400 mg 12-hourly for 3 months for: Albendazole Echinococcus
-inoperable cases, granulosus
-preoperative to reduce infectivity (Canine
tapeworm
-postoperative to prevent recurrence. causing
Hydatid
20 mg/kg.b.w. 12-hourly for 2 weeks Praziquantel disease)
kills protoscolices perioperatively.
Surgical excision for
Large, symptomatic
cysts or complicated
Cysts.

Percutaneous Puncture Aspiration PAIR technique

Injection Reaspiration
 Intestinal nematode Infections
Dosage Drug Infection
100 mg tablet twice/day for Mebendazole (Antiver) Ascaris
3 days or 500 mg single dose Irreversibly blocking uptake of lumbricoides
glucose and other nutrients
400 mg (2 tablets) single Albendazole(Alzental,Vermizole
Decreases ATP production in
oral dose
worm causing death
Single oral dose of 10 Pyrantel pamoate (Combantrin)
mg/kg b.w. Spastic paralysis of the worm by
inhibiting cholinestrase
Piperazine citrate
4 g as a single oral dose.
Flaccid paralysis of the worm by
blocking response to ACh

2.5 mg/Kg b.w. single oral Levamisole (Ketrax)

Dose
If there is no cure a second course should be given within 2-3 weeks
 Intestinal nematode Infections (cont.)

Dosage Drug Infection

100 mg tablet twice/day for Mebendazole (Antiver) Ancylostoma
3 days or 500 mg single dose duodenale
(Hook worm)

400 mg (2 tablets) single Albendazole(Alzental,Vermizole

oral dose

Single oral dose of 10 Pyrantel pamoate (Combantrin)

mg/kg b.w.

Oral iron therapy for treatment

of iron deficiency anemia.
 Intestinal nematode Infections (cont.)
Dosage Drug Infection
100 mg tablet single dose Mebendazole (Antiver) Enterobius
vermicularis

400 mg (2 tablets) single Albendazole(Alzental,Vermizole (Pin worm)

oral dose

Single oral dose of 10 Pyrantel pamoate (Combantrin)

mg/kg b.w.
Proper personal hygiene.

Treatment of the whole family

at the time even asymptomatic?
Treatment may be repeated within 2 weeks to control autoinfection
 Intestinal nematode Infections (cont.)
Dosage Drug Infection
25 mg/kg.b.w. twice/day for Thiabendazole (Mintezole) Strongyloides
3 days orally (tablet 500 mg) stercoralis
Repeated after 2 weeks

200 g/kg.b.w./day for 1-2 Ivermectin (Stromectol).

days

2 tablets (tablet 200 mg) Albendazole(Alzental,Vermizole

twice/day for 3 days

2 tablets (tablet 100 mg) Mebendazole (Antiver)

twice/day for 3 days
Treatment should be continued for 7 days in hyperinfestation syndrome
 Intestinal nematode Infections (cont.)
Dosage Drug Infection
100 mg tablet twice/day for Mebendazole (Antiver) Trichuris
3 days or 500 mg single dose trichiura
(whip worm)
400 mg (2 tablets) single Albendazole(Alzental,Vermizole
oral dose
 Tissue nematode Infections
Dosage Drug Infection
6mg/kg.b.w. orally daily in 3 Diethyl carbamazine DEC Wuchereria
divided doses (tablet 50 mg) (Hetrazan) bancrofti
for 3 weeks.
Start with a small dose 50 Brugia malayi
mg/day and double the dose
Loa loa
daily until the full dose is
(african
reached eye worm)

150-200 g/kg.b.w./day Ivermectin Onchocerca

Single oral dose to be May be used alone or in volvulus
repeated every 2-3 months Combination with DEC, but it is
for 2 years the drug of choice in
Onchocerciasis
 Tissue nematode Infections (cont.)
Dosage Drug Infection
Extracting the worm by Dracanculus
winding it out gently round a medinensis
match stick over several
days.

250 mg three times/day for Metronidazole

10 days.

100 mg twice daily for 7days. Mebendazole

These drugs may reduce

inflammation and aid
extraction of the worm.
 Zoonotic nematode Infections
Dosage Drug Infection
400 mg/day orally for 7 days Albendazole (Alzental) Toxocara canis and
(tablet 200 mg). cati
(causing visceral
50 mg/kg.b.w. daily for 1-4 Thiabendazole
larva migrans)
weeks.

100 mg t.d.s for 3 weeks. Diethyl carbamazine

(Hetrazan)
10% solution of topical Ancylostoma
thiabendazole. braziliense and A.
caninum
400 mg/day orally for 2 days. Albendazole (causing cutaneous
larva migrans)
400 mg twice/day for 7 days Albendazole Trichinella spiralis
Steroids in severe cases