Table 1. Approaches to Anthelmintic Therapy In Patients With Uncomplicated and Complicated Strongyloidiasis or

Who Fail to Respond to Initial Therapy. All Drugs are Administered Orally except where indicated. Anthelmintics are

Listed in Order of Preference. Dosing regimens are based on trials and case reports referenced in the main text.

Initial regimens for uncomplicated strongyloidiasis

· Ivermectin 200 mg/kg once or on two consecutive days

· Albendazole 400 mg twice daily for 3 days

· Cambendazole 5 mg/kg once

· Thiabendazole 25 mg/kg twice daily for 3 days

Regimens for eradication of S. stercoralis in patients with uncomplicated strongyloidiasis who fail to respond to the initial regimen or for the attempted eradication of S. stercoralis in immunosuppressed patients who do not have disseminated disease

· Ivermectin 200 mg/kg weekly for 4 weeks

· Albendazole 400 mg daily for 3 weeks

· Mebendazole 100 mg daily for 3 weeks

Regimens for the initial treatment of severe, complicated strongyloidiasis in immunosuppressed patients

· Ivermectin 200 mg/kg twice weekly for 2 weeks, then weekly for 4 weeks, then monthly for 3 months

· Albendazole 400 mg twice daily for 14 days

· Cambendazole 5 mg/kg daily for 10-20 days

· Thiabendazole 25 mg/kg twice daily for 20 days

Regimens for the initial treatment of severe, complicated strongyloidiasis in patients unable to take oral therapy

· subcutaneous veterinary preparations of ivermectin (eg Panomec® or Ivomec®) 200 mg/kg twice weekly then switch to standard oral route when possible

· rectal ivermectin 200 mg/kg in a retention enema (eg 30mls Ora-Plus®or Keltrol) daily for 7 days

. rectal thiabendazole 1.5g in 15ml retention enema daily for 14 days

Regimens for containment of strongyloidiasis in immunosuppressed patients in whom infection cannot be eradicated

· Ivermectin 200 mg/kg for one day each month

· Albendazole 400 mg for one day each month

· Thiabendazole 25 mg/kg twice a day for one day each month

Table 2. Recent Studies of The Efficacy of Ivermectin In Uncomplicated Strongyloidiasis.

References	Regimen	Number of patients	Time till evaluation	Cure rate (%)
48	ivermectin 50-200 mg/kg once or twice on consecutive days	101	1 month	67-100
63	ivermectin 6 mg twice, 2 weeks apart	125	?	86
18	i. ivermectin 200 mg/kg once ii. ivermectin 200 mg/kg twice on consecutive days iii. thiabendazole 50 mg/kg bd for 3 days	15 17 17	6 months	100 100 94
16	i. ivermectin 150- 200 mg/kg once ii albendazole 400 mg daily for 3 days	24 29	3 months	83 38
40	i. ivermectin 200 mg/kg once ii albendazole 400 mg daily for 3 days	152 149	3 weeks	83 45
67	i. ivermectin 6 mg once ii albendazole 400 mg daily for 3 days iii. pyrvinium 5 mg/kg daily for 3 days	67 84 60	12 months	97 77 23
51	i. ivermectin 200mg/kg once ii. albendazole 400mg twice daily for 5 days	78 33	1 month	99 77
65	i. veterinary ivermectin 200mg/kg once ii. albendazole 400mg twice daily for 7 days	21 21	median 19 days median 13 days	76 38

Figure 1. Typical rash of larva currens in a Caucasian traveller.

Photograph courtesy of Hospital for Tropical Diseases, London, UK

Figure 2: Rhabditiform larva of Strongyloides stercoralis.

Photograph courtesy of Hospital for Tropical Diseases, London, UK

Figure 3: Duodenal biopsy in a patient with Strongyloides hyperinfection The larvae are seen within the lumen

of the crypts. The intestinal mucosa, which is densely inflamed, shows the presence of an adult worm, larvae and eggs.

Photograph courtesy of Hospital for Tropical Diseases, London, UK