AJTMH Transactions of the Royal Society of Tropical Medicine and Hygiene
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Am. J. Trop. Med. Hyg., 68(4), 2003, pp. 453-455
Copyright © 2003 by The American Society of Tropical Medicine and Hygiene

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CASE REPORT: RECTAL ADMINSTRATION OF IVERMECTIN TO A PATIENT WITH STRONGYLOIDES HYPERINFECTION SYNDROME

PHILIP E. TARR*, PETER S. MIELE*, KENNETH S. PEREGOY, MARGO A. SMITH, FRANKLIN A. NEVA, AND DANIEL R. LUCEY
Section of Infectious Diseases, Department of Medicine, and Department of Pharmacy, Washington Hospital Center, Washington, District of Columbia; Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

 

ABSTRACT

Strongyloides hyperinfection syndrome may be complicated by paralytic ileus that interferes with the absorption of oral anti-helminthics. We report on the administration of ivermectin as a rectal enema preparation to a renal transplant recipient with Strongyloides hyperinfection syndrome and progressive ileus. Attempts at treatment using nasogastric albendazole and ivermectin were unsuccessful despite clamping the nasogastric tube after drug administration. Ivermectin tablets were ground to a powder, resuspended in a commercially available suspending agent, and administered per rectum. The suspending agent was chosen for its near-physiologic osmolality to allow longer retention, in contrast to many enema preparations that have a laxative effect. The patient improved markedly within 72 hours of initiation of the therapy per rectum and recovered fully. Ivermectin administered as an enema may be beneficial in patients with severe strongyloidiasis who are unable to absorb or tolerate oral therapy.

Received September 20, 2002. Accepted for publication November 6, 2002.

Acknowledgments: We are grateful to Drs. Timothy Light, Jimmy Light, Thomas C. Jones, and Nancy Pietroski for helpful discussions.

Authors’ addresses: Philip E. Tarr, Peter S. Miele, Margo A. Smith, and Daniel R. Lucey, Section of Infectious Diseases, Washington Hospital Center, Room 2A-56, 110 Irving Street NW, Washington, DC 20010. Kenneth S. Peregoy, Department of Pharmacy, Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010. Franklin A. Neva, Laboratory of Parasitic Diseases, Building 4, Room B1-27, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892.

Reprint requests: Philip E. Tarr, Division of Infectious Diseases, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne, Switzerland, Telephone: 41-21-314-1010, Fax: 41-21-314-1018, E-mail: philiptarr{at}yahoo.com

* These authors contributed equally to this publication.




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