BNF for Children 2011-2012

346 5.5.4 Drugs for hookworms BNFC 2011–2012gastro-intestinal upset, lightheadedness, and pruritus; itis not effective against larval worms. Fears of developingcysticercosis in Taenia solium infections haveproved unfounded. All the same, an antiemetic can begiven before treatment and a laxative can be given 2hours after niclosamide.Praziquantel [unlicensed] is available from Merck Serono(Cysticide c ); it is as effective as niclosamide and isgiven to children over 4 years of age as a single dose of5–10 mg/kg after a light breakfast (or as a single dose of25 mg/kg for Hymenolepis nana).Praziquantel [unlicensed] is available from Merck Serono(Cysticide c ) and is effective against all humanschistosomes. In children over 4 years the dose is20 mg/kg followed after 4–6 hours by a further dose of20 mg/kg (20 mg/kg 3 times daily for one day for S.japonicum infections). No serious adverse effects havebeen reported. Of all the available schistosomicides, ithas the most attractive combination of effectiveness,broad-spectrum activity, and low toxicity.5 InfectionsHydatid diseaseCysts caused by Echinococcus granulosus grow slowlyand asymptomatic children do not always require treatment.Surgical treatment remains the method of choicein many situations. Albendazole [unlicensed] (availablefrom ‘special-order’ manufacturers or specialist importingcompanies, see p. 809 is used in conjunction withsurgery to reduce the risk of recurrence or as primarytreatment in inoperable cases. Albendazole is given tochildren over 2 years of age in a dose of 7.5 mg/kg twicedaily (max. 400 mg twice daily) for 28 days followed by14-day break and then repeated for up to 2–3 cycles.Alveolar echinococcosis due to E. multilocularis isusually fatal if untreated. Surgical removal with albendazolecover is the treatment of choice, but where effectivesurgery is impossible, repeated cycles of albendazole(for a year or more) may help. Careful monitoringof liver function is particularly important during drugtreatment.5.5.4 Drugs for hookworms(ancylostomiasis, necatoriasis)Hookworms live in the upper small intestine and drawblood from the point of their attachment to their host.An iron-deficiency anaemia may occur and, if present,effective treatment of the infection requires not onlyexpulsion of the worms but treatment of the anaemia.Mebendazole (section 5.5.1) has a useful broad-spectrumactivity, and is effective against hookworms.Albendazole [unlicensed] (available from ‘specialorder’manufacturers or specialist importing companies,see p. 809) given as a single dose of 400 mg in childrenover 2 years, is an alternative. Levamisole is alsoeffective (section 5.5.2).5.5.5 Schistosomicides(bilharziasis)Adult Schistosoma haematobium worms live in thegenito-urinary veins and adult S. mansoni in those ofthe colon and mesentery. S. japonicum is more widelydistributed in veins of the alimentary tract and portalsystem.5.5.6 FilaricidesDiethylcarbamazine [unlicensed] (available from ‘special-order’manufacturers or specialist importing companies,see p. 809) is effective against microfilariae andadult worms of Loa loa, Wuchereria bancrofti, andBrugia malayi. To minimise reactions, treatment inchildren over 1 month is commenced with a dose ofdiethylcarbamazine citrate 1 mg/kg in divided doses onthe first day and increased gradually over 3 days to6 mg/kg daily (3 mg/kg daily if child under 10 years) individed doses; length of treatment varies according toinfection type, and usually gives a radical cure for theseinfections. Close medical supervision is necessary particularlyin the early phase of treatment. In heavy infectionsthere may be a febrile reaction, and in heavy Loaloa infection there is a small risk of encephalopathy. Insuch cases specialist advice should be sought, andtreatment must be given under careful in-patient supervisionand stopped at the first sign of cerebral involvement.Ivermectin [unlicensed] (available from ‘special-order’manufacturers or specialist importing companies, seep. 809) is very effective in onchocerciasis and it is nowthe drug of choice. In children over 5 years, a singledose of 150 micrograms/kg by mouth produces a prolongedreduction in microfilarial levels. Retreatment atintervals of 6 to 12 months depending on symptomsmust be given until the adult worms die out. Reactionsare usually slight and most commonly take the form oftemporary aggravation of itching and rash. Diethylcarbamazineor suramin should no longer be used foronchocerciasis because of their toxicity.5.5.7 Drugs for cutaneous larvamigrans(creeping eruption)Dog and cat hookworm larvae may enter human skinwhere they produce slowly extending itching tracksusually on the foot. Single tracks can be treated withtopical tiabendazole (no commercial preparation available).Multiple infections respond to ivermectin,albendazole or tiabendazole (thiabendazole) bymouth (all unlicensed and available from ‘specialorder’manufacturers or specialist importing companies,see p. 809).