Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria hospital, Negrar, Italy.
Ospedale La Carità, Ospedale regionale di Locarno, Locarno, Switzerland.
Expert Opin Pharmacother. 2022 Oct;23(14):1617-1628. doi: 10.1080/14656566.2022.2114829. Epub 2022 Aug 24.
Strongyloidiasis, an infection caused by the soil-transmitted helminth , can lead immunocompromised people to a life-threatening syndrome. We highlight here current and emerging pharmacotherapeutic strategies for strongyloidiasis and discuss treatment protocols according to patient cohort. We searched PubMed and Embase for papers published on this topic between 1990 and May 2022.
Ivermectin is the first-line drug, with an estimated efficacy of about 86% and excellent tolerability. Albendazole has a lower efficacy, with usage advised when ivermectin is not available or not recommended. Moxidectin might be a valid alternative to ivermectin, with the advantage of being a dose-independent formulation.
The standard dose of ivermectin is 200 µg/kg single dose orally, but multiple doses might be needed in immunosuppressed patients. In the case of hyperinfection, repeated doses are recommended up to 2 weeks after clearance of larvae from biological fluids, with close monitoring and further dosing based on review. Subcutaneous ivermectin is used where there is impaired intestinal absorption/paralytic ileus. In pregnant or lactating women, studies have not identified increased risk with ivermectin use. However, with limited available data, a risk-benefit assessment should be considered for each case.
由土壤传播的蠕虫感染引起的弱虫病，可能使免疫功能低下的人患上危及生命的综合征。我们在此强调当前和新兴的弱虫病药物治疗策略，并根据患者群体讨论治疗方案。我们在 1990 年至 2022 年 5 月期间在 PubMed 和 Embase 上搜索了关于该主题的论文。
伊维菌素是一线药物，估计疗效约为 86%，且具有极好的耐受性。阿苯达唑疗效较低，当无法获得或不建议使用伊维菌素时建议使用。莫昔克丁可能是伊维菌素的有效替代品，其优点是剂量独立制剂。
伊维菌素的标准剂量为 200µg/kg 单次口服，但免疫抑制患者可能需要多次剂量。在严重感染的情况下，建议在清除生物体液中的幼虫后 2 周内重复给药，密切监测，并根据病情进一步给药。皮下注射伊维菌素用于肠道吸收/麻痹性肠梗阻受损的情况。在孕妇或哺乳期妇女中，研究并未发现使用伊维菌素会增加风险。然而，由于数据有限，应针对每个病例进行风险效益评估。
