Intestinal Parasites

Beverley-Ann Biggs, Margaret Kay, Aesen Thambiran

Recommendations

  • Check for eosinophilia
  • If documented pre-departure albendazole therapy:
    • no eosinophilia and no symptoms – no investigation or treatment required.
    • eosinophilia – perform stool microscopy for ova cysts and parasites (OCP) followed by directed treatment.
  • If no documented pre-departure albendazole therapy, depending on local resources and practices there are two acceptable options:
    • empiric single-dose albendazole therapy (age >6 months, weight <10kg; 200mg; ≥10kg; 400mg). If eosinophilia at baseline re-check in 8 weeks. If eosinophilia persists perform stool microscopy for OCP

OR

    • perform stool microscopy OCP followed by directed treatment. Recheck eosinophils and stool microscopy OCP at 8 weeks after directed treatment.
  • Refer if unable to find cause of eosinophilia.
  • Treat pathological helminths with albendazole (age > 6 months, weight <10kg; 200mg; ≥10kg; 400mg) for three days, except for Ascaris lumbricoides, which only requires 400mg as a single dose (200mg in children >6 months and <10 kg). Mebendazole is an option for some parasites.136
  • Treat giardiasis with tinidazole 2g as a single dose, (50mg/kg in children, maximum 2g), or metronidazole 2g daily for three days (30mg/kg in children, maximum 2g).148
  • In people with positive stool microscopy, follow up with stool microscopy at 2-4 weeks after treatment and re-treat if necessary.
  • Refer refractory cases to an ID specialist.

Avoid albendazole (class D) and mebendazole (class B3) in pregnancy, both can be used during lactation.149

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