Treatment of Strongyloidiasis

Introduction to Treatment

The recommended treatment for strongyloidiasis is ivermectin at a dose of 200 μg/kg orally for 2 consecutive days, which provides the highest cure rate with excellent tolerability, according to the Journal of Infection guidelines 1

For immunocompromised patients, the recommended regimen is ivermectin 200 μg/kg on days 1, 2, 15, and 16, as suggested by the Journal of Infection 1
Assess if the patient is immunocompromised or will require corticosteroid therapy, as these factors significantly increase risk of hyperinfection syndrome, as stated by Clinical Infectious Diseases 2, 3

Monitor for symptoms of hyperinfection syndrome, including gastrointestinal bleeding, pneumonia, sepsis, or meningitis, as warned by Gut 4
Avoid initiating corticosteroid therapy without first treating strongyloidiasis, as this can precipitate potentially fatal hyperinfection syndrome, according to Clinical Infectious Diseases 5, 3

Clinical manifestations of Strongyloides infections may include larva currens, an itchy, linear, urticarial rash that typically moves several millimeters per second around the trunk, upper legs, and buttocks 6
Albendazole 400 mg daily for 3 days is an alternative but less effective option, with cure rates of only 38-63% compared to ivermectin's 77-100% 6
For cutaneous larva migrans, treatment options include ivermectin (200 mg/kg as a single dose) or albendazole (400 mg daily for 3 days) 6

Patients receiving corticosteroids or other immunosuppressive therapy should be screened and treated for Strongyloides before initiating immunosuppression, as recommended by the Infectious Diseases Society of America 7
Consider empiric treatment for patients from endemic areas who will be receiving immunosuppressive therapy, even without confirmed diagnosis, as suggested by the Clinical Infectious Diseases guideline 7