Infection

Drug

Adult dosage

Pediatric dosage

ACANTHAMOEBA keratitis

Drug of choice:

see footnote¹

AMEBIASIS (Entamoeba histolytica)

asymptomatic

Drug of choice:

Iodoquinol²

650 mg PO tid X 20d

30–40 mg/kg/d (max. 2g) PO in 3 doses X 20d

OR

Paromomycin³

25–35 mg/kg/d PO in 3 doses X 7d

25–35 mg/kg/d PO in 3 doses X 7d

OR

Diloxanide furoate^4*

500 mg PO tid X 10d

20 mg/kg/d PO in 3 doses X 10d

mild to moderate intestinal disease

Drug of choice:⁵

Metronidazole

500–750 mg PO tid X 7–10d

35–50 mg/kg/d PO in 3 doses X 7–10d

OR

Tinidazole⁶

2 g once PO daily X 3d

>3yrs: 50 mg/kg/d (max. 2g) PO in 1 dose X 3d

either followed by

Iodoquinol²

650 mg PO tid X 20d

30–40 mg/kg/d (max. 2g) PO in 3 doses X 20d

OR

Paromomycin³

25–35 mg/kg/d PO in 3 doses X 7d

25–35 mg/kg/d PO in 3 doses X 7d

  severe intestinal and extraintestinal disease

Drug of choice:

Metronidazole

750 mg PO tid X 7–10d

35–50 mg/kg/d PO in 3 doses X 7-10d

OR

Tinidazole⁶

2 g once PO daily X 5d

>3yrs: 50 mg/kg/d (max. 2g) PO in 1 dose X 3d

either followed by

Iodoquinol²

650 mg PO tid X 20d

30–40 mg/kg/d (max. 2g) PO in 3 doses X 20d

OR

Paromomycin³

25–35 mg/kg/d PO in 3 doses X 7d

25–35 mg/kg/d PO in 3 doses X 7d

AMEBIC MENINGOENCEPHALITIS, primary and granulomatous

Naegleria

Drug of choice:

Amphotericin B⁷,⁸

1.5 mg/kg/d IV in 2 doses X 3d, then 1 mg/kg/d X 6d plus 1.5 mg/d intrathecally X 2d, then 1 mg/d every other day X 8d

1.5 mg/kg/d IV in 2 doses X 3d, then 1 mg/kg/d x 6d plus 1.5 mg/d intrathecally X 2d, then 1 mg/d every other day X 8d

Acanthamoeba

Drug of choice:

⁹

Balamuthia mandrillaris

Drug of choice:

¹⁰

Sappinia diploidea

Drug of choice:

¹¹

ANCYLOSTOMA caninum (Eosinophilic enterocolitis)

Drug of choice:

Albendazole⁷,¹²

400 mg PO once

400 mg PO once

OR

Mebendazole

100 mg PO bid X 3d

100 mg PO bid X 3d

OR

Pyrantel pamoate⁷,^13*

11 mg/kg (max. 1g) PO X 3d

11 mg/kg (max. 1g) PO X 3d

OR

Endoscopic removal

Ancylostoma duodenale, see HOOKWORM

ANGIOSTRONGYLIASIS (Angiostrongylus cantonensis, Angiostrongylus costaricensis)

Drug of choice:

¹⁴

ANISAKIASIS (Anisakis spp.)

Treatment of choice:¹⁵

Surgical or endoscopic removal

ASCARIASIS (Ascaris lumbricoides, roundworm)

Drug of choice:⁵

Albendazole⁷,¹²

400 mg PO once

400 mg PO once

OR

Mebendazole

100 mg bid PO X 3d or 500 mg once

100 mg PO bid X 3d or 500 mg once

OR

Ivermectin⁷,¹⁶

150-200 mcg/kg PO once

150-200 mcg/kg PO once

Babesiosis(Babesia microti)

Drug of choice:¹⁷

Clindamycin⁷,¹⁸

1.2 g bid IV or 600 mg tid PO X 7–10d

20–40 mg/kg/d PO in 3 doses X 7–10d

plus quinine⁷,¹⁹

650 mg PO tid X 7–10d

30 mg/kg/d PO in 3 doses X 7–10d

OR

Atovaquone⁷,²⁰

750 mg PO bid X 7–10d

40 mg/kg/d PO in 2 doses X 7–10d

plus azithromycin⁷

600 mg PO daily X 7–10d

12 mg/kg/d PO X 7–10d

Balamuthia mandrillaris, see AMEBIC MENINGOENCEPHALITIS, PRIMARY

BALANTIDIASIS (Balantidium coli)

Drug of choice:

Tetracycline⁷,²¹

500 mg PO qid X 10d

40 mg/kg/d (max. 2 g) PO in 4 doses X 10d

Alternative:

Metronidazole⁷

750 mg PO tid X 5d

35-50 mg/kg/d PO in 3 doses X 5d

OR

Iodoquinol²,⁷

650 mg PO tid X 20d

30-40 mg/kg/d (max 2 g) PO in 3 doses X 20d

BAYLISASCARIASIS (Baylisascaris procyonis)

Drug of choice:

²²

BLASTOCYSTIS hominis infection

Drug of choice:

²³

CAPILLARIASIS (Capillaria philippinensis)

Drug of choice:

Mebendazole⁷

200 mg PO bid X 20d

200 mg PO bid X 20d

Alternative:

Albendazole⁷,¹²

400 mg PO daily X 10d

400 mg PO daily X 10d

Chagas’ disease, see TRYPANOSOMIASIS

Clonorchis sinensis, see FLUKE infection

CRYPTOSPORIDIOSIS (Cryptosporidium) Non-HIV infected

Drug of choice:

Nitazoxanide⁵

500 mg PO bid X 3d

• 1–3yrs: 100 mg PO bid X 3d

• 4–11yrs: 200 mg PO bid X 3d

• >12yrs: 500 mg PO q12h X 3d

HIV infected

Drug of choice:

²⁴

CUTANEOUS LARVA MIGRANS (creeping eruption, dog and cat hookworm)

Drug of choice:²⁵

Albendazole⁷,¹²

400 mg PO daily X 3d

400 mg PO daily

OR

Ivermectin⁷,¹⁶

200 mcg/kg PO daily X 1–2d

200 mcg/kg PO daily X 1–2d

CYCLOSPORIASIS (Cyclospora cayetanensis)

Drug of choice:²⁶

Trimethoprim/sulfamethoxazole⁷

TMP 160 mg/SMX 800 mg (1 DS tab) PO bid X 7–10d

TMP 10 mg/kg/SMX 50 mg/kg/d PO in 2 doses X 7–10d

CYSTICERCOSIS, see TAPEWORM infection

DIENTAMOEBA fragilis infection²⁷

Drug of choice:

Iodoquinol²,⁷

650 mg PO tid X 20d

30–40 mg/kg/d (max. 2g) PO in 3 doses X 20d

OR

Paromomycin³,⁷

25–35 mg/kg/d PO in 3 doses X 7d

25–35 mg/kg/d PO in 3 doses X 7d

OR

Tetracycline⁷,²¹

500 mg PO qid X 10d

40 mg/kg/d (max. 2g) PO in 4 doses X 10d

OR

Metronidazole⁷

500–750 mg PO tid X 10d

35–50 mg/kg/d PO in 3 doses X 10d

Diphyllobothrium latum, see TAPEWORM infection

DRACUNCULUS medinensis (guinea worm) infection

Drug of choice:

²⁸

Echinococcus, see TAPEWORM infection

Entamoeba histolytica, see AMEBIASIS

ENTEROBIUS vermicularis (pinworm) infection

Drug of choice:²⁹

Mebendazole

100 mg PO once; repeat in 2wks

100 mg PO once; repeat in 2wks

OR

Pyrantel pamoate^13*

11 mg/kg base PO once (max. 1 g); repeat in 2wks

11 mg/kg base PO once (max. 1 g); repeat in 2wks

OR

Albendazole⁷,¹²

400 mg PO once; repeat in 2wks

400 mg PO once; repeat in 2wks

Fasciola hepatica, see FLUKE infection

FILARIASIS³⁰

Wuchereria bancrofti, Brugia malayi, Brugia timori

Drug of choice:³¹

Diethylcarbamazine^*

6 mg/kg/d PO in 3 doses X 12d³²,³³

6 mg/kg/d PO in 3 doses X 12d³²,³³

Loa loa

Drug of choice:³⁴

Diethylcarbamazine^*

6 mg/kg/d PO in 3 doses X 12d³²,³³

6 mg/kg/d PO in 3 doses X 12d³²,³³

Mansonella ozzardi

Drug of choice:

³⁵

Mansonella perstans

Drug of choice:

Albendazole⁷,¹²

400 mg PO bid X 10d

400 mg PO bid X 10d

OR

Mebendazole⁷

100 mg PO bid X 30d

100 mg PO bid X 30d

Mansonella streptocerca

Drug of choice:³⁶

Diethylcarbamazine^*

6 mg/kg/d PO X 12d³³

6 mg/kg/d PO X 12d³³

OR

Ivermectin⁷,¹⁶

150 mcg/kg PO once

150 mcg/kg PO once

Tropical Pulmonary Eosinophilia (TPE)³⁷

Drug of choice:

Diethylcarbamazine^*

6 mg/kg/d in 3 doses X 12–21d³³

6 mg/kg/d in 3 doses X 12–21d³³

Onchocerca volvulus (River blindness)

Drug of choice:

Ivermectin¹⁶,³⁸

150 mcg/kg PO once, repeated every 6–12 mos until asymptomatic

150 mcg/kg PO once, repeated every 6-12 mos until asymptomatic

FLUKE, hermaphroditic, infection

Clonorchis sinensis (Chinese liver fluke)

 Drug of choice:

Praziquantel³⁹

75 mg/kg/d PO in 3 doses X 2d

75 mg/kg/d PO in 3 doses X 2d

OR

Albendazole⁷,¹²

10 mg/kg/d PO X 7d

10 mg/kg/d PO X 7d

Fasciola hepatica (sheep liver fluke)

Drug of choice:⁴⁰

Triclabendazole^*

10 mg/kg PO once or twice⁴¹

10 mg/kg PO once or twice⁴¹

Alternative:

Bithionol^*

30-50 mg/kg on alternate days X 10–15 doses

30–50 mg/kg on alternate days X 10-15 doses

OR

Nitazoxanide⁵,⁷

500 mg PO bid X 7d

• 1–3yrs: 100 mg PO q12h X 7d

• 4–11yrs: 200 mg PO q12h X 7d

• >12yrs: 500 mg PO q12h X 7d

Fasciolopsis buski, Heterophyes heterophyes, Metagonimus yokogawai (intestinal flukes)

Drug of choice:

Praziquantel⁷,³⁹

75 mg/kg/d PO in 3 doses X 1d

75 mg/kg/d PO in 3 doses X 1d

Metorchis conjunctus (North American liver fluke)

Drug of choice:

Praziquantel⁷,³⁹

75 mg/kg/d PO in 3 doses X 1d

75 mg/kg/d PO in 3 doses X 1d

Nanophyetus salmincola

Drug of choice:

Praziquantel⁷,³⁹

60 mg/kg/d PO in 3 doses X 1d

60 mg/kg/d PO in 3 doses X 1d

Opisthorchis viverrini (Southeast Asian liver fluke)

Drug of choice:

Praziquantel³⁹

75 mg/kg/d PO in 3 doses X 2d

75 mg/kg/d PO in 3 doses X 2d

Paragonimus westermani (lung fluke)

Drug of choice:

Praziquantel⁷,³⁹

75 mg/kg/d PO in 3 doses X 2d

75 mg/kg/d PO in 3 doses X 2d

Alternative:⁴²

Bithionol^*

30-50 mg/kg on alternate days X 10–15 doses

30–50 mg/kg on alternate days X 10–15 doses

GIARDIASIS(Giardia duodenalis)

Drug of choice:

Metronidazole⁷

250 mg PO tid X 5–7d

15 mg/kg/d PO in 3 doses X 5–7d

OR

Tinidazole⁶

2 g PO once

50 mg/kg PO once (max. 2 g)

OR

Nitazoxanide⁵

500 mg PO bid X 3d

• 1–3yrs: 100 mg PO q12h X 3d

• 4–11yrs: 200 mg PO q12h X 3d

• >12yrs: 500 mg PO q12h X 3d

Alternative:⁴³

Paromomycin³,⁷,⁴⁴

25–35 mg/kg/d PO in 3 doses X 5–10d

25–35 mg/kg/d PO in 3 doses X 5-10d

OR

Furazolidone^*

100 mg PO qid X 7–10d

6 mg/kg/d PO in 4 doses X 7–10d

OR

Quinacrine⁴,^45*

100 mg PO tid X 5d

6 mg/kg/d PO in 3 doses X 5d (max 300 mg/d)

GNATHOSTOMIASIS(Gnathostoma spinigerum)⁴⁶

Treatment of choice:

Albendazole⁷,¹²

400 mg PO bid X 21d

400 mg PO bid X 21d

OR

Ivermectin⁷,¹⁶

200 mcg/kg/d PO X 2d

200 mcg/kg/d PO X 2d

Either

± Surgical removal

GONGYLONEMIASIS (Gongylonema sp.)⁴⁷

Treatment of choice:

Surgical removal

OR

Albendazole⁷,¹²

400 mg/d PO X 3d

400 mg/d PO X 3d

HOOKWORM infection (Ancylostoma duodenale, Necator americanus)

Drug of choice:

Albendazole⁷,¹²

400 mg PO once

400 mg PO once

OR

Mebendazole

100 mg PO bid X 3d or 500 mg once

100 mg PO bid X 3d or 500 mg once

OR

Pyrantel pamoate⁷,^13*

11 mg/kg (max. 1g) PO X 3d

11 mg/kg (max. 1g) PO X 3d