Beverley-Ann Biggs, Margaret Kay, Aesen Thambiran
- 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
- 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