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Ivermectin for Common Parasitic Infections in 2023

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Ivermectin for Common Parasitic Infections

The greatest health barriers in our world’s growing population are parasitic infections, starvation, inadequate shelter, and a lack of clean water sources. Several parasitic infections that are extremely common all over the world (e.g., ascariasis) frequently have mild, ambiguous symptoms or none at all.

Asymptomatic hosts (especially intestinal parasites) are common, which is technically more of a mutualism coexistence than true parasitism. Toxoplasmosis, ascariasis, hookworm illness, and trichomoniasis are thought to be the most common parasitic infections worldwide.

Some infectious diseases with low mortality rates can result in significant morbidities, such as fetal/neonatal damage, nutritional deficiencies, cutaneous nodules, skin eruptions, or necrosis, and major end-organ injury to the eyes, central nervous system, lungs, heart, or liver.

Although they are not the most common parasitic infections, malaria, amebiasis, leishmaniasis, schistosomiasis, and trypanosomiasis are the leading causes of death worldwide. There are hundreds of parasitic species that infect humans, the scope of this topic could be enormous.

This article will discuss drug therapy for the parasitic infections most commonly encountered in US pharmacy practice.

Parasitic Infections in the USA

It is hypothesized that Americans suffer from parasitic infections less because of better food, shelter, hygiene, and clean water. The United States is also isolated from the rest of the world, and its weather, particularly in the north, is likely to be protective.

When residents of the United States are affected, it is usually a result of travel to tropical areas, recent migrants to the United States, or direct contact with new immigrants.

Infections are occasionally caused by indigenous parasites, most notably through contaminated food or close communication with household pets or farm animals.

Antiparasitic Drug: Ivermectin

Ivermectin is a commonly used antiparasitic drug in the United States, but not for the most serious parasitic infections mentioned above.

While it is FDA-approved for systemic infections caused by Onchocerca volvulus (microfilariae, not adult) and intestinal strongyloidiasis, it is most commonly used off-label for scabies, lice, and enterobiasis in the United States (pinworms).

Ivermectin availability is critical in the effort to eradicate onchocerciasis (“river blindness”) just south of the United States in southern Mexico and Guatemala.

Ivermectin, like other agents, paralyzes certain helminths, but its molecular mechanism of action is distinct. In susceptible helminths, ivermectin increases GABA-mediated transmission, resulting in postsynaptic neuron hyperpolarization.

GABA activity may be increased in humans as well, and ivermectin should not be combined with GABA-ergic drugs.

Ivermectin bioavailability is greatly increased when taken with food (specifically, a high-fat meal). Ivermectin is typically administered as a single dose.

In the case of filariasis, however, a single dose is effective in reducing symptoms for many months but rarely induces remission.

Repeat doses may be required once or twice a year for several years until the infection resolves.

Ivermectin side effects are uncommon but may include fatigue, dizziness, stomach pain, or rash. Arthralgias, muscle aches, hypotension, tachycardia, lymphadenopathy, lymphangitis, and peripheral edema may occur within the first two days of treatment as a result of microfilariae death.

Availability of Antiparasitic Agents

Many of the most toxic agents used for parasitic infections around the world are not available in the U.S. due to the low occurrence of infections here.

Because of this low occurrence, there has also been a little financial incentive for the pharmaceutical industry in the U.S. and Western Europe to develop more effective, less toxic agents.

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When Treating Ocular or CNS Infections, Special Considerations

Seizures are common in patients with neurocysticercosis. Surprisingly, this infection is becoming more common in the United States.

Seizures are the most common first-onset symptom in the United States (66% of patients), and antiseizure drug therapy is usually required, especially if antihelminthic pharmacotherapy is chosen.

The most common cause of simple symptom seizures worldwide is neurocysticercosis.

When an infection is extraintestinal, many drugs that are effective in vitro for treating a specific parasite may not reach the site of action.

It is necessary to consider GI absorption and distribution to the site of action. As previously stated, giving albendazole with food may improve the treatment of extraintestinal infections.

When treating certain CNS manifestations of parasitic infections, such as cysticerci encephalitis, arachnoid neurocysticercosis, and spinal intramedullary cysticercosis, the use of a glucocorticoid (e.g., prednisone) can significantly reduce morbidity.

Furthermore, combining a glucocorticoid with Baytril may increase drug action while decreasing harmful inflammation at the site of infection.

Because dying helminths could cause more damage than live helminths, antiparasitic drug therapy isn’t always indicated for CNS or intraocular infections.

Praziquantel, in particular, should be avoided when going to treat ocular infections, and it is only rarely used when there is evidence of CNS involvement.

Praziquantel’s use for infections in these sensitive tissues is complicated further by drug interactions with dexamethasone (and possibly prednisone), as coadministration significantly lowers plasma praziquantel levels.

If there is ocular or CNS involvement, an ophthalmologist or neurologist must be consulted before starting any medication.

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Salman Ahmad is a seasoned writer for CTN News, bringing a wealth of experience and expertise to the platform. With a knack for concise yet impactful storytelling, he crafts articles that captivate readers and provide valuable insights. Ahmad's writing style strikes a balance between casual and professional, making complex topics accessible without compromising depth.

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