Gastroenteritis - Parasitic (1 of 13)
1 Patient presents w/ signs & symptoms suggestive of gastroenteritis
2 DIAGNOSIS Do history & lab results No support parasitic infection? ALTERNATIVE DIAGNOSIS • Consider viral or bacterial gastroenteritis Yes - Please see Gastroenteritis - Viral or Gastroenteritis - Bacterial disease management charts for further information Protozoal or helminthic infection? Helminthic infection Protozoal infection
A Non-pharmacological therapy PHARMACO • Rehydration & nutrition THERAPY FOR - Oral rehydration solution (ORS) HELMINTHIC • Education about preventive measures INFECTIONS See next page
B RECOMMENDED THERAPY FOR PROTOZOAL PARASITES Drug Pathogen Preferred Agents Alternative Agents Cryptosporidium sp Nitazoxanide - Entamoeba histolytica (Amoebiasis) Paromomycin Iodoquinol or Diloxanide • Asymptomatic cyst passer furoate E histolytica (Amoebiasis) Metronidazole or Tinidazole - • Mild-moderate intestinal disease E histolytica (Amoebiasis) Metronidazole or Tinidazole - • Severe intestinal disease or liver abscess Giardia lamblia (Giardiasis) In most immunocompetent patients, giardiasis is self-limiting & does not require treatment. In nonendemic areas, asymptomatic carriers of giardiasis are treated Metronidazole, Nitazoxanide Furazolidone, Paromomycin © MIMSor Tinidazole or Quinacrine
Not all products are available or approved for above use in all countries. Specifi c prescribing information may be found in the latest MIMS.
B1 © MIMS PEDIATRICS 2020 GASTROENTERITIS - PARASITIC Schistosoma mansoniSchistosoma japonicumSchistosoma haematobiumSchistosoma Paragonimus (Lung fl westermani ukes) liver flAsian uke) (Southeast viverrini Opisthorchis (Intestinal flukes) Metagonimusheterophyes, yokogawai Heterophyes Fasciolopsis buski, (Fascioliasis) Fasciola hepatica sinensisClonorchis (Oriental liver fluke) Trematodes (Flukes) trichiura Trichuris (Strongyloidiasis) pamoate, Pyrantel stercoralis Strongyloides (Pinworm) Enterobius vermicularis philippinensis (Capillariasis) Capillaria Praziquantel nana (dwarf tapeworm) Hymenolepis tapeworm) Diphyllobothrium (fi latum sh or broad caninum, Diphyllobothrium Taenia tapeworm) (Asian asiatica Taenia, solium tapeworm) (pork Taenia, tapeworm) (beef saginata (Tapeworms) Cestodes (Hookworms) or Ivermectin Albendazole, (Ancylostomiasis) americanus Necator Ancylostoma duodenale, (Ascariasis) lumbricoides Ascaris (Roundworms) Nematodes Pathogen • Repeat lab ifnecessary todocument eradication exams ofparasite, Repeat
© MIMS Mebendazole (Whipworm) C Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not RECOMMENDED THERAPY FOR HELMINTHS Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing A atoneii aaii 2of13) Gastroenteritis -Parasitic (2 Non-pharmacological therapy Non-pharmacological • • - Rehydration &nutrition Education about preventive measures Education about HELMINTHIC INFECTIONS HELMINTHIC Oral rehydration (ORS) solution Praziquantel Praziquantel Praziquantel Praziquantel Praziquantel Praziquantel Triclabendazole Praziquantel Ivermectin orMebendazole Albendazole Mebendazole Praziquantel Praziquantel Pyrantel pamoate or Pyrantel Mebendazole Albendazole, Mebendazole FOLLOWUP Preferred Agents B2 Drug Albendazole orIvermectin Albendazole Oxamniquine Triclabendazole orBithionol Albendazole Bithionol orNitazoxanide Albendazole iabendazole or Albendazole Albendazole or Niclosamide Niclosamide Niclosamide Nitazoxanide Alternative Agents © MIMS - - - - - Nitazoxanide PEDIATRICS 2020 GASTROENTERITIS - PARASITIC Signs &Symptoms Signs ofTransmission Mode totheir According Parasites • • • • Tests Lab Other • ofStools Exam Microscopic TestsLab • Exam Physical • • • • • Infections Parasitic Gastrointestinal Factors in Susceptibility Host • • History Clinical • • • • • • • • Fasciola hepatica infection Fasciola hepatica inpatients evidence w/suspected supportive considered as be biopsy,Liver tomography may studies abdominal imaging computerized (eg scan) axial ultrasound, abdominal Sudan stainformalabsorption infection ofhookworm cases insevere especially Anemia seen may be - w/helminthic infections especially seen may Eosinophilia be - on the count complete seen may blood (CBC) be Anemia &eosinophilia studies Barium - Cellophane test tape - chain (PCR) reaction polymerase immunosorbent (ELISA), assay Enzyme-linked - Immunofluorescent test antibody - test capsule String - Biopsy - aspirate Duodenal - necessary as infection, todocument aparasitic that are other used efollowing may tests be - - - Fundamental infections parasitic ofallgastrointestinal tothe diagnosis Findings are nonspecific Presence ofamalignancy Intercurrent disease Age (newborn) Immunosuppressive drugs statusNutritional inthe ishelpful diagnosis ofparasites distribution ofthe geographic Knowledge barefoot) walking orraw ofundercooked ingestion fimeat, water endemic, where may infresh certain be parasites sh, swimming forhelminthic (eg infections eating undercooked especially Attempt exposure, ofpossible toelicit ahistory claudication & fatigue anemia, arthralgia, pruritus, skinrashes, hematuria, dysuria, vulvovaginitis, wheezing, hemoptysis, cough, dyspnea, seizures, headache, eg tosymptoms occur &may rise also give can infection Extraintestinal colic vomiting&biliary malabsorption, prolapse, dyspepsia, pain,dysentery, abdominal fl include diarrhea, ifpresent, symptoms, Gastrointestinal atulence, jaundice, rectal patientsSome asymptomatic may be pruritus) edema, anorexia, (eg weight infections fever,for parasitic loss, sweating, fatigue, malaise, Frequently, donothave that any infections &symptoms patients are parasitic signs specifi w/gastrointestinal c Entamoeba histolytica Water-borne Schistosoma haematobium/japonicum/mansoni, sp.,Giardia lamblia, parasites: Cryptosporidium Paragonimus Fasciola hepatica, sp. viverrini, Clonorchis Opisthorchis sinensis, trematodes: Food-borne stercoralis, Trichuris trichiura Ancylostoma Strongyloides Necator lumbricoides, americanus, duodenale, helminths: Ascaris Soil-transmitted skinpenetration water orby ingestion, or food route by tohumans the transmitted may fecal-oral via symptoms be causing gastrointestinal Parasites © infeces distributed uniformly are never eggs well sample examination before because mixed mustA fecal be MIMSworms oradult larvae proglottids, helminth &trophozoites, ova, protozoan cysts todetect isused exam estool used shouldbe technique, usingaconcentration personnel trained by examined &apermanent stain specimens, A minimum of3stool 1 GASTROINTESTINAL PARASITIC INFECTIONS Gastroenteritis -Parasitic (3of13) 2 DIAGNOSIS B3 © MIMS PEDIATRICS 2020 GASTROENTERITIS - PARASITIC • • • • Losses &Electrolyte ofFluid Replacement • • Hydration &NutritionAdequate &NutritionRehydration • • • • • • • • • Measures Preventive About Education • TransfusionBlood &Treatment w/Ferrous sulfate fl foreach given amount tobe eWHO-recommended onweight &age follows: are as based uid loss in1Lofwater ofsugar ofsalt& 6teaspoons or½teaspoon of245mOsm/L, glucose w/totalosmolarity concentrationORS mmol/L the by recommended World 75 75mEq/Lsodium, Health Organization(WHO): replacement& electrolyte May initiate oralrehydration therapy usingoralrehydration forpatients (ORS) w/indications forfl solution uid ofdehydration forsigns assessed be Vomiting infl result &diarrhea patients &these should &potassium, mainlysodium losses, uid &electrolyte Ensure that patient’s nutritional &hydration status are at maintained acceptable levels malnutrition frequentlyPatients infections suff w/parasitic in resulting vomiting&diarrhea, er malabsorption, from Compost of human waste to kill infective forms ofparasites forms tokillinfective ofhumanCompost waste material toavoid fecal contamination by orwater crops supplies &wastewater offood ofsewage disposal Proper (eginfections enterobiasis) Targeted contacts like treating chemotherapy family ofapatient may w/certain prevent infections, parasitic water the &check pool’s pool ispossible level, pH&chlorine avoid swallowing When going swimming, route ofinfection toinhibitthe soil-to-skin Use of footwear untreated water drinking orusingice from Refrain untreated from water sources Wash water intreated &vegetables fruits - Meat &fi properlysh must cooked be - frequently Kitchen utensils washed must be - transmission consumption) before &fruit fecal-oral tointerrupt allvegetables hygiene (eg washing food Good route oftransmissionmany parasites orurinary-oral tointerrupt the fecal-oral Handwashing hygiene, oftransmission &prevention oftransmission routes personal regarding Health education anemia which may severe infections cause inhookworm necessary may be measures ese 16-29.9 kg (35 lb, 4 oz - 65 lb, 15 oz) 5-14 years 12002200 mL 12002200 5-14years 16-29.9 kg(35lb,4oz -65lb,15oz) 8-10.9 kg (17 lb, 10 oz - 24 lb) 12-23 months 600800 mL 600800 12-23months 8-10.9 kg(17lb,10oz -24lb) 11-15.9 kg(24lb,4oz -35lb) 5-7.9 kg (11 lb - 17 lb, 7 oz) 4-11 months 200400 mL 200400 4-11months 5-7.9 kg(11lb-17lb,7oz) 30 kg(66lb,2oz) ormore <5 kg(11lb) © MIMSWeight Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing A NON-PHARMACOLOGICAL THERAPY Gastroenteritis -Parasitic (4of13) <4 months ≥15 years 2-4 years Age Amount (within the Amount (within Age B4 22004000 mL 22004000 fi 4hours) rst 8001200 mL 8001200 200400 mL 200400 © MIMS PEDIATRICS 2020 GASTROENTERITIS - PARASITIC • pamoate Pyrantel • pamoate Oxantel • • Mebendazole • Ivermectin • • Bithionol • • • Albendazole Anthelminthics • • Nitazoxanide • • Furazolidone • Drugs Antiprotozoal Other • • • • • Amoebicides Luminal • • Tissue Amoebicides • forTreatmentDrugs ofAmoebiasis Used forthe treatmentUsed ofintestinal nematodes for Ttrichiura analternative treatment incombination as orIvermectin option used w/Albendazole ofPyrantel, An analogue ofsideeff frequency inalow resulting the from GItract, Poorly absorbed ects Widely fortreatment used ofintestinal nematodes First-line therapy Sstercoralis against weight, except &/or<15kgbody inpatients loainfection, w/Loa symptoms) &gastrointestinal reactions photosensitivity antigens ofworm mayRelease (eg reactions cause urticaria, Alternative agent when Triclabendazole for Fhepatica isunavailable orcontraindicated w/intake offatty tract absorption meal gastrointestinal Improved eff Also &roundworms certain against hookworms ective - Widely forintestinal nematode infections used activity ofantiparasitic anexceptionallyHas broad-spectrum Alternative therapy Fhepatica against Treatment ofchoice &cryptosporidium forgiardiasis Furazolidone eff isas inthe Metronidazole treatment as ofgiardiasis ective forthe treatmentUsed ofgiardiasis Eg Furazolidone, Quinacrine Nitazoxanide, &giardiasis intreatment used ofcryptosporidiosis be May also - - w/Ehistolytica ofchoice intestinal Drug infection forasymptomatic - Paromomycin treatment relapse isfrequent w/aluminalamoebicide ismandatory, otherwise further treatment orliver abscess, after foramoebic dysentery persists carriage cyst When asymptomatic To spread prevent secondary - To disease avoid invasive the ofdeveloping risk - passers cyst forasymptomatic Recommended infection inpatients Ehistolytica w/asymptomatic used May be - agents ese are eff intreating organisms lumenective inthe bowel ParomomycinEg Diloxanide (preferred) Iodoquinol, furoate, lumen bowel agents ese are eff eff butare less amoebiasis intreating invasive ective intreating organismsective inthe TinidazoleEg Ornidazole, Metronidazole, Treatment agent aluminalcysticidal by followed be w/atissue-activeamoebicide shouldalways cryptosporidiosis patientsTemporarily whohave (HIV) virus inhuman eliminates diarrhea immunodeficiency C B PHARMACOLOGICAL FOR THERAPY HELMINTHIC INFECTIONS © MIMS PHARMACOLOGICAL THERAPY FOR PROTOZOAL INFECTIONS Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Gastroenteritis -Parasitic (5of13) B5 © MIMS PEDIATRICS 2020 GASTROENTERITIS - PARASITIC • • • • • • • • • • Triclabendazole • • iabendazole • • • • • Praziquantel (Cont'd) Anthelminthics gastroenteritis gastroenteritis gelatinHuman tannate &other toconclude studied milk, are probiotics being their inthe use management of toxic megacolon colon, perforated Surgical GIbleeding, intervention considered may massive inpatients be w/obstruction, Hematinics foranemia may help restore hemoglobin level - - control) inthegastrointestinaltract immune functions(egphagocytosis,antigenpresentation,antimicrobialactivityviachelation,infl ammation infl ammatory cytokines,&growthfactors thatmayhelpprovidepassiveimmunitybyenhancingdiff erent Bovine colostrumcontainsantimicrobialpeptides(lactoferrin,lactoperoxidase),immune-regulating& - anadjunctive therapy as inacutediarrhea agent, used may be anantisecretory Racecadotril, - gastroenteritis inrotavirus used May be - toreduce the intensity shown inchildren haveProbiotics diarrhea &duration been ofacuteinfectious Patients x10-14days may 20mg/day give ≥6months, PO - For patients x10-14days may 10mg/day give upto6months, PO - &reduce the incidence inthe next2-3months ofdiarrhea illness, ofdiarrheal the duration &severity may ofdiarrhea decrease supplementation anepisode during given Zinc fl forIV avoid the need ofdiarrhea episodes uid, butmay increase vomitingorhelp Antiemetic inchildren agents ofage >4years (eg todecrease used may Ondansetron) be Not routinely forchildren recommended ofage ≤4 years Treatment ofchoice infection forpatients w/Fhepatica ofuntoward effHigh frequency &the availability ofalternative agentsects usefulness its have limited intissues forms Active many against &larval intestinal adultnematodes ofepilepsy w/caution inpatients use lassitude); w/history antigens of worm in the may patientRelease elicit responses (eg N/V, headache, pain, dizziness, abdominal resistance chemotherapyDrug incountries isapossibility, practicingmass acontrol as especially measure helminthiasis & soil-transmitted Combination therapy for schistosomiasis or Mebendazole w/ Albendazole is used Highly eff spthat humans allSchistosoma against infect ective ofcestodes form ofchoiceDrug forliver fl Clonorchis sinensis), (egviverrini, intestinalukes fl Opisthorchis &adultlarval ukes, C clinical trials clinical benefiClinical t inthe prevention &management in iscurrently diarrhea determined ofinfectious being occurrence &duration inchildren diarrhea ofdiarrhea) w/infectious frequency, (eg stool symptoms clinical reduced improved colostrum reduced thatStudies bovine showed in children w/acutediarrhea duration outputadministration diarrhea stool following & reduced of Racecadotril decreased Studies showed Lactobacillus spp,Saccharomyces Bifi boulardii, Eg dobacterium spp © MIMS PHARMACOLOGICAL THERAPY FOR HELMINTHIC INFECTIONS (CONT'D) Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Gastroenteritis -Parasitic (6of13) ADJUNCTIVE THERAPY B6 © MIMS PEDIATRICS 2020 GASTROENTERITIS - PARASITIC Metronidazole (Quinacrine) Mepacrine furoate) (Diloxanide Diloxanide (Iodoquinol) quinoline Diiodohydroxy- Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed
©8 hrly x5-7 days divided 15 mg/kg/day PO Giardiasis: MIMS x5-10 days 8 hrly divided 35-50 mg/kg/day PO disease: intestinal/hepatic Amoebic 300 mg/day dose: Max 5-7 days 8 hrly x PO 2 mg/kg/dose Giardiasis: ifnecessary repeated May be 8 hrly x10 days divided 20 mg/kg/day>25 kg: PO passer): cyst (asymptomatic E histolytica 6-8 hrly x20 days divided >30 mth: 5-10 mg/kg/day PO passer): cyst (asymptomatic E histolytica Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage Gastroenteritis -Parasitic (7of13) Dosage Guidelines ANTIAMOEBICS Adverse Reactions Adverse B7 GIeff (flects atulence, N/V,• diarrhea); • • • Instructions Special • • Reactions Adverse • Instructions Special • Reactions Adverse • • Instructions Special • • Reactions Adverse • eff (anorexia) ect effDermatologic Other urticaria); (pruritus, ects therapy during isnotadvisable alcoholicDrinking beverage clinical monitoringforCNSeffects >10 daysIf given recommend CBC monitoring & dyscrasias blood disease, CNS Use w/ caution inpatients w/hepatic impairment, neuropathy seizures &epileptiform peripheral caused has use orprolonged High dose reactions hypersensitivity darkening of urine) anorexia, infection, effOther changes); mood headache, (Candidal ects effconstipation); CNS dizziness, (weakness, ects GI eff (N/V,ects diarrhea, taste, metallic psychosis porphyria, hepatic disease, Avoid inpatients use w/psoriasis, Other eff (ocular toxicity,ects anemia) aplastic blue/black discolorationurine; ofpalate &nails); yellow discolorationreversible ofskin,conjunctiva, (during large longadministration orafter doses: eff (N/V,ects eff hepatotoxicity); Dermatologic ects effCNS convulsions); headache, GI (dizziness, ects disorders orneurological thyroid disease children andpatients w/ Use w/caution ininfants, hyperthyroidism, enterohepatic acrodermatitis neuropathy, hepatic orrenal impairment; w/pre-existing optic those hydroxyquinolines, orhalogenated toiodine hypersensitivity in patientsContraindicated w/known at highdoses neuropathy may administration occur w/prolonged damage orinfl nerve Optic ammation &peripheral enlargementeruptions, ofthe thyroid gland); contentrelated toiodine ani,skin (pruritus GI eff N/V, cramps, (abdominal ects E diarrhea); Hematologic &hepaticHematologic effRarely have occurred; ects Neurotoxicity Remarks © MIMS PEDIATRICS ff ects 2020 GASTROENTERITIS - PARASITIC Tinidazole Secnidazole Paromomycin Nitazoxanide Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products Max dose: 2 g/day dose: Max once, ifnecessary repeated May be singledose 50-75 mg/kgPO > 3 yr: Giardiasis: 2 g/day dose: Max daily x5 days once 50-60 mg/kg/day PO > 3 yr: disease: hepatic Amoebic 2 g/day dose: Max daily x3 days once 50-60 mg/kg/day PO > 3 yr: disease: intestinal Amoebic singledose 30 mg/kg PO Giardiasis: x5 days doses divided or singledose 30 mg/kg/day PO disease: hepatic Amoebic x3 days25 mg/kg/day PO 4 hrx1day within or doses divided orin2 singledose 30 mg/kg PO disease: intestinal Amoebic 15minx4 doses every 11 mg/kg PO latum Tsolium, D Tapeworm (Tsaginata, 7 days 8 hrly x divided 25-35 mg/kg/day PO Giardiasis: 8 hrly25-35 mg/kg/day x5-10 days PO Cryptosporidiosis: May be repeated after 2 wk after repeated May be 5-10 days 8 hrly x divided 25-35 mg/kg/day PO disease: intestinal Amoebic x3 days 500 mgPO12 hrly ≥12 yr: 4-12 yr: 12 hrly x3 days 100 mgPO 1-3 yr: Giardiasis: placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed © MIMS ): Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not 200 mg PO 12 hrly x3 days 200 mg PO Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage Gastroenteritis -Parasitic (8of13) ANTIAMOEBICS (CONT’D) ANTIAMOEBICS Dosage Guidelines B8 • • • Instructions Special • • Reactions Adverse • • Instructions Special • • Reactions Adverse • Instructions Special • Reactions Adverse • Precautions: Special • EffAdverse ects: • • safety &effisafety established have notbeen cacy Use w/caution inpatients ofage ≤3 yr since eff forCNS monitoring & clinical ects >10 daysIf given recommend CBC monitoring dyscrasias blood disease, impairment, CNS Use w/ caution inpatients w/hepatic neuropathy seizures peripheral &epileptiform caused has use orprolonged High dose darkening ofurine) anorexia, infection, (Candidal changes); mood headache, effconstipation); CNS dizziness, (weakness, ects GI eff (N/V, ects diarrhea, taste, metallic eff forCNS monitoring & clinical ects >10 daysIf given recommend CBC monitoring dyscrasias blood disease, impairment, CNS Use w/ caution inpatients w/hepatic neuropathy seizures peripheral &epileptiform caused has use orprolonged High dose darkening ofurine) (anorexia, effOther changes); mood headache, ects effconstipation); CNS dizziness, (weakness, ects GI eff (N/V,ects diarrhea, taste, metallic motility, renal orneuromuscular disorders Use w/caution inpatients w/impaired GI effnephrotoxicity &neuromuscular blocking ects May have potential Ototoxicity; & diarrhea); steatorrhea w/severe syndrome malabsorption oraltherapy prolonged heartburn, may produce GIeffanaphylaxis); (N/V,ects cramps, abdominal fever, drug pruritus, (rashes, reactions effCNS Hypersensitivity vertigo); (headache, ects disease hepatic orbiliary renal, Use w/caution inpatients w/diabetes, eff (headache) ect GI eff CNS N/V); pain,diarrhea, (abdominal ects Rarely hypersensitivity reactions Rarely hypersensitivity &hepaticHematologic eff have occurred; ects reactions Rarely hypersensitivity &hepaticHematologic eff have occurred; ects Remarks © O MIMS ther eff ects PEDIATRICS 2020 GASTROENTERITIS - PARASITIC Bithionol Albendazole Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products - onalternate days x10 30-50 mg/kg PO : P westermani a totalof10-15 doses onalternate days for 30-50 mg/kg PO : F hepatica 24hrly x3 days 400 mgPO >2 yr: Tsolium): Tapeworm (Tsaginata, singledose 400 mgPO >2 yr: singledose 200 mgPO <2 yr: T trichiura: x3 days singledose 400 mgPO >2 yr: x3 days singledose 200 mgPO <2 yr: Strongyloidiasis: >2 yr: O viverrini: singledose 400 mgPO >2 yr: singledose 200 mgPO <2 yr: Hookworms: 24hrly x5 days 400 mgPO 2-12 yr: Giardiasis: infection in2-3 wkforheavy repeated May be singledose 400 mgPO ≥2 yr: singledose 200 mgPO <2 yr: Enterobiasis: x10 days 400 mg/day PO >2 yr: Capillariasis: >2 yr: C sinensis: singledose 400 mgPO >2 yr: singledose 200 mgPO <2 yr: Ascariasis: placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed © 15 doses MIMS 400 mg PO 12 hrly x3 days 400 mgPO 400 mg PO 12 hrly x3 days 400 mg PO Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage Gastroenteritis -Parasitic (9of13) Dosage Guidelines ANTHELMINTICS B9 • Reactions Adverse • • Instructions Special • Reactions Adverse (skin rashes) eff Dermatologic headache); (dizziness, ect eff CNS salivation); diarrhea, discomfort, ects GI eff N/V, (anorexia, ects abdominal of therapy completion 1 month at avoided least shouldbe Pregnancy age impairment, women ofchildbearing Use w/caution inpatients w/hepatic eff (alopecia) ect Hematologic eff Dermatologic (leukopenia); ect eff CNS enzymes); dizziness); (headache, ects GI eff pain,N/V, (abdominal ects liver elevated Remarks © MIMS PEDIATRICS 2020 GASTROENTERITIS - PARASITIC Niclosamide Mebendazole Ivermectin Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products 250 mg PO 12 hrly 250 mgPO <2 yr: 12 hrly 500 mgPO 2-8 yr: 12 hrly 1 gPO >8 yr: solium,): Dcaninum &Dlatum T Tapeworms (Tsaginata, 3 days x singledose 500 mgPO >2 yr: or 12 hrly x3 days 100 mg dailyPO T trichiura: >2 yr: or 12 hrly x3 days 100 mg PO Hookworms: in2-3 wk ifnecessary May repeat singledose 500 mgPO >2 yr: Enterobiasis: 20 12 hrly x 200 mgPO >2 yr: Capillariasis: singledose 500 mgPO >2 yr: or x3 days 12 hrly 100 mg dailyPO Ascariasis: 24 hrly x 2 days ≥80 kg:200mcg/kg/day PO 24 hrly 66-79 kg:15 mgPO 24 hrly 51-65 kg:12 mgPO 24 hrly 36-50 kg:9 mgPO 24 hrly 25-35 kg:6 mgPO 24 hrly 15-24 kg:3 mgPO Strongyloidiasis: single dose a as ≥15 kg:150-200mcg/kgPO Ascariasis: placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed
© MIMSdays 500 mg PO singledose 500 mg PO Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage Gastroenteritis -Parasitic (10of13) ANTHELMINTICS (CONT’D) ANTHELMINTICS Dosage Guidelines B10 • Reactions Adverse • • Instructions Special • Reactions Adverse • • Instructions Special • Reactions Adverse Dermatologic effDermatologic rarely, (pruritus, rash) ects eff CNS Mild GIsymptoms, (lightheadedness); ect established notbeen since has safety Patients ofage <2 yr are relative contraindications treatment prolonged during &liver function Monitor CBC reactions) allergic depression, marrow bone enzymes, Other eff rash); (alopecia, liver (elevated ects eff eff Dermatologic dizziness); (headache, ects ects GI eff CNS N/V); pain,diarrhea, (abdominal ects than inolder patients developed less may brainbarrier be since blood Use w/caution inpatients of age <2 yr or<15kg doses repeated after especially reactions monitor foradverse to administration; may after need Supervision lymphadenopathy) Other eff(pruritus); (Fever,ect edema, eff eff Dermatologic irritation); (mildocular ect ect effCNS Ocular myalgia); arthralgia, (headache, ect Remarks © MIMS PEDIATRICS 2020 GASTROENTERITIS - PARASITIC Praziquantel Oxantel Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products 5-25 mg/kg PO singledose 5-25 mg/kg PO Tapeworms: for1day singledose 40 mg/kg PO or 12 hrly x1day PO 20 mg/kg/dose : S mansoni 1 day for singledose 40-60 mg/kg PO or for 1day 4-6 hrly x3 doses 20 mg/kg PO : S mekongi S japonicum, for1day singledose 40 mg/kg PO or 12 hrly x1day PO 20 mg/kg/dose : S haematobium singledose 40 mg/kg PO or 8 hrly x2-3 days 25 mg/kg PO : P westermani singledose 40 mg/kg PO or 8 hrly x2-3 days 25 mg/kg PO : O viverrini singledose 40 mg/kg PO or 8 hrly x1-2 days 25 mg/kg PO Myokogawai): heterophyes, flIntestinal H (Fbuski, ukes singledose 40 mg/kg PO or 8 hrly x1-3 days 25 mg/kg PO : C sinensis single dose 10-20 mg/kgPO W/ Pyrantel: : T orientalis Hookworms, Enterobiasis, single dose 10-20 mg/kgPO W/ Pyrantel: singledose 10-20 mg/kg PO (Ttrichiura ): Whipworm placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed © MIMS Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage Gastroenteritis -Parasitic (11of13) ANTHELMINTICS (CONT’D) ANTHELMINTICS Dosage Guidelines B11 • • • Instructions Special • Reactions Adverse • Instructions Special • Reactions Adverse Doses are for children old ≥4 yr Doses ofseizures history disease, Use hepatic w/caution inpatients w/severe ofthe parasite destruction damage from resulting eye ofsevere ofrisk because inpatients cysticercosis notuse w/ocular Do eosinophilia) (fever, skinrashes, urticaria, reactions Hypersensitivity malaise); headache, s eff CNS diarrhea); dizziness, t (drowsiness, ects c ff e GI e dysfunction Use w/caution inpatients hepatic w/preexisting Other eff drowsiness); insomnia, rash) (anorexia, ects eff CNS diarrhea); dizziness, (headache, ect GI eff pain,GIdisturbances, (abdominal ects (N/V, anorexia, discomfort, abdominal Remarks © MIMS PEDIATRICS 2020 GASTROENTERITIS - PARASITIC Triclabendazole ( iabendazole) Tiabendazole pamoate) (Pyrantel Pyrantel Furazolidone Drug Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed 10 days upto given May be 6 hrly x2-5 days PO 1.25 mg/kg/dose Giardiasis: © MIMS 12 hrly x2doses 10 mg/kgPO ≥6 yr: : F hepatica 3 g/day dose: Max disease nated >5 days given fordissemi- May be asingledose as 50 mg/kg/day PO or 12 hrly x2-3 days 25 mg/kg PO Strongyloidiasis: once dailyx3 days10 mg/kg PO Hookworms: 1 g/day dose: Max 2 wk after repeated May be singledose 10 mg/kg PO Enterobiasis: 1 g/day dose: Max singledose 10 mg/kg PO Ascariasis: Dosage Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing OTHER ANTIPROTOZOALAGENTS Gastroenteritis -Parasitic (12of13) Dosage ANTHELMINTICS (CONT’D) ANTHELMINTICS Dosage Guidelines • • Instructions Special • Reactions Adverse producing hemolytic anemia hemolytic producing inpatientsContraindicated <1mth of duetopossibility periods forprolonged largeadministering doses Use w/ caution inpatients w/G6PDdefi when ciency eff (N/V,ects darkening ofthe urine) allergic skinreactions, effCNS Other malaise); headache, drowsiness, (dizziness, ects B12 • Instructions Special • Reactions Adverse • Instructions Special • Reactions Adverse • Instructions Special • Reactions Adverse galactose/lactose defigalactose/lactose ciency glucose malabsorption, galactosemia, congenital syncope), pathologies (arrhythmia, Use w/ caution inpatients w/cardiac pain,fever, chest weakness, dorsalpain,cough) (jaundice, itching); Other eff (sweating, ects eff Dermatologic headache); (dizziness, ects eff CNS ofappetite); decrease/loss ects GI eff pain,N/V, (abdominal ects diarrhea, dehydration impairment, malnutrition, anemia or Use w/caution inpatients w/hepatic orrenal hyperglycemia) orparenchymal(liver cholestasis damage, s Hematologic eff t Other eff (leukopenia); ect c ects ff e e Dermatologic effof color Otic vision); (tinnitus); ect eff Ocular drowsiness); fatigue, (disturbanceect s effpain); CNS t dizziness, (headache, ects c ff e GI e malnutrition impairment, anemia, Use w/caution inpatients w/hepatic skinrashes) liver enzymes, Other eff insomnia); drowsiness, (elevated ects diarrhea); GI eff (N/V,ects cramps, abdominal anorexia, Remarks (anorexia, N/V, (anorexia, abdominal diarrhea, CNS effCNS dizziness, (headache, ects Remarks (pruritus, rashes); rashes); (pruritus, © MIMS PEDIATRICS 2020 GASTROENTERITIS - PARASITIC Bacillus clausii Bacillus Racecadotril boulardiiSaccharomyces Lyophilized L rhamnosus, Lsporogenes) Lacidophilus, (L reuteri, Lactobacillus spp smectite Dioctahedral anhydrous) citrate, Glucose KCl, Trisodium Glucose (NaCl, Potassium chloride, Trisodium citrate, chloride, Sodium Lactobacillus spp Lactobacillus spp Bovine colostrum Bovine Streptococcus thermophilus Streptococcus Binfantis)/ (B breve, Bifi dobacterium spp L rhamnosus, Lbulgaricus)/ Lacidophilus, casei, (L ADJUNCTIVE AGENTS ADJUNCTIVE Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Drug Drug Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed © MIMS for the 1st2hr, then upto2hrly 4x (5.125g)PO 1sachet >5 yr: for the 1st2hr, then upto4hrly 3x (5.125g)PO 1sachet 2-5 yr: the 1st2hr, then upto8hrly for (5.125g)PO 1sachet <2 yr: Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing billion/5 mLsusp of2 1-2 vials 7days duration: Max daily doses 3 divided days: Subsequent daily doses 2 divided then w/1initialdose PO 1:1.5mg/kg/dose Day 24hrly 250 mgPO 24hrly 450 mgPO doses 2-3 divided in 6-9g/day PO >2 yr: doses 2-3 divided in 3-6g/day PO 1-2 yr: doses divided in2-3 3g/day PO <1 yr: SUPPLEMENTS &ADJUVANT THERAPY Please see the end of this section for the reference list. reference the for section this of end the see Please days x3 day (7g)PO ≥12 mth:1sachet/ 4hrly x4-7days 24 (1g)PO 1 sachet Gastroenteritis -Parasitic (13of13) Dosage Dosage Dosage Dosage Guidelines ANTIDIARRHEALS ELECTROLYTES B13 • • Instructions Special • • Instructions Special Use w/ caution inpatients tomilk&/oregg w/allergy the contentsMix w/30mLwater of1packet inacup milk Use w/caution inpatients tofi w/allergy or sh, soya milk/juice Contents tofood/water/ ofthe added may sachet be • • • Instructions Special • • • • Reactions Adverse broad-spectrum antibiotic broad-spectrum &highfever, w/ stool bloody associated diarrhea defisucrase-isomaltase ciency, w/ acutedysentery syndrome, malabsorption galactose intolerance,impairment, glucose& fructose inpatients w/renal used orhepatic be shouldnot smectite &Dioctahedral Racecadotril on antibiotic therapy orcurrentlyimmunocompromised, orpreviously caution inpatients allergic toyeast, w/ Lyophilized used Saccharomyces shouldbe toortaken w/ water, food diluted May be tea, milk, constipation, headache N/V, may rarely drowsiness, Racecadotril cause constipation, flatulence, thirst Lyophilized Saccharomyces may cause Lactobacillus may intestinal fl cause atus may aggravate smectite constipationDioctahedral • • Instructions Special • Reactions Adverse glucose malabsorption, vomiting, inability to drink inability todrink vomiting, glucose malabsorption, dehydration, diarrhea, &prolonged severe severe Use w/ caution inpatients w/renal impairment, in250mLwater 1sachet Dissolve Na&water retention, N/V Hypernatremia, Remarks Remarks Remarks © MIMS PEDIATRICS 2020