1921
Volume 73, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

We report the case of a 23-year-old Caribbean man with disseminated strongyloidiasis (co-infected with human T cell lymphotropic virus I/II)), severe hypoalbuminemia, and a paralytic ileus. Subcutaneous ivermectin (200 μg/kg) was administered daily for 14 days because of the inability to effectively administer oral albendazole and oral ivermectin. Three hours after the third daily dose of oral ivermectin, the serum ivermectin concentration was only 0.8 ng/mL, but it increased several fold to 5.8 ng/mL 16 hours after the first dose of subcutaneous ivermectin. During the course of subcutaneous treatment, ivermectin clearance was higher than expected (46.0 L/hour, normal = 31.8 L/hour). This is likely the result of severe hypoalbuminemia since ivermectin is highly protein bound. The ability to achieve adequate levels of ivermectin after oral administration in patients with disseminated strongyloidiasis may be impaired, highlighting the need for alternative routes of administration of ivermectin in these patients.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.2005.73.911
2005-11-01
2017-11-18
Loading full text...

Full text loading...

/deliver/fulltext/14761645/73/5/0730911.html?itemId=/content/journals/10.4269/ajtmh.2005.73.911&mimeType=html&fmt=ahah

References

  1. Genta RM, 1989. Global prevalence of strongyloidiasis: critical review with epidemiologic insights into the prevention of disseminated disease. Rev Infect Dis 11 : 755–767.
  2. Mahmoud AAF, 2000. Intestinal nematodes (roundworms). Mandell G, Douglas R, Bennett J, eds. Principles and Practice of Infectious Diseases. Volume 2. Philadelphia: Churchill Livingstone, 2938–2943.
  3. Tarr P, Miele P, Peregoy K, Smith M, Neva F, Lucey D, 2003. Case report: rectal administration of ivermectin to a patient with Strongyloides hyperinfection syndrome. Am J Trop Med Hyg 68 : 453–455.
  4. Boken D, Leoni P, Preheim L, 1993. Treatment of Strongyloides stercoralis hyperinfection syndrome with thiabendazole administered per rectum. Clin Infect Dis 16 : 123–126.
  5. Chiodini P, Reid A, Wiselka M, Firmin R, Foweraker J, 2000. Parenteral ivermectin in Strongyloides hyperinfection. Lancet 355 : 43–44.
  6. Guzzo CA, Furtek CI, Porras AG, Chen C, Tipping R, Clineschmidt CM, Sciberras DG, Hsieh JY, Lasseter KC, 2002. Satety, tolerability, and pharmacokinetics of escalating high doses of ivermectin in healthy adult subjects. J Clin Pharmacol 42 : 1122–1133.
  7. Fink D, Porras A, Pharmacokinetics of ivermectin in animals and humans. Campbell W, ed. Ivermectin and Abamectin. New York: Springer-Verlag, 1989:113–130.
  8. Chen Y, Fleckenstein L, 2002. Liquid choromatographic assay of moxidectin in human plasma for application to pharmacokinetic studies. J Pharmaceut Biomed Anal 29 : 917–926.
  9. Echeverria J, Mestorino N, Errecalade J, 2002. Comparative pharmacokinetics of ivermectin after its subcutaneous administration in healthy sheep and sheep infected with mange. J Vet Pharmacol Ther 25 : 159–160.
  10. Lanusse C, Lifschitz A, Virkel G, Alvarez L, Sanchez S, Sutra JF, Galtier P, Alvinerie M, 1997. Comparative plasma disposition kinetics of ivermectin, moxidectin and doramectin in cattle. J Vet Pharmacol Ther 20 : 91–99.
  11. Toutain P, Upson D, Terhune T, McKenzie M, 1997. Comparative pharmacokinetics of doramectin and ivermectin in cattle. Vet Parasitol 72 : 3–8.
  12. Alvinerie M, Sutra J, Galtier P, 1993. Ivermectin in goat plasma and milk after subcutaneous injection. Vet Res 24 : 417–421.
  13. Barber S, Bowles V, Lespine A, Alvinerie M, 2003. The comparative serum disposition kinetics of subcuataneous administration of doramectin, ivermectin and moxidecin in the Australian Merino sheep. J Vet Pharmacol Ther 26 : 343–348.
  14. Marriner S, McKinnon I, Bogan J, 1987. The pharmacokinetics of ivermectin after oral and subcuataneous administration to sheep and horses. J Vet Pharmacol Ther 10 : 175–179.
  15. Baraka O, Mahmoud B, Marschke C, Gerary T, Homeida M, Williams J, 1996. Ivermectin distribution in the plasma and tissues of patients infected with Onchocerca volvulus. Eur J Clin Pharmacol 50 : 407–410.
  16. Edwards G, Dingsdale A, Helsby N, Orme M, Breckenridge A, 1988. The relative systemic availability of ivermectin after administration as capsule, tablet, and oral solution. Eur J Clin Pharmacol 35 : 681–684.
  17. Njoo FL, Beek WM, Keukens HJ, van Wilgenburg H, Oosting J, Stilma JS, Kijlstra A, 1995. Ivermectin detection in serum of onchocerciasis patients: relationship to adverse reactions. Am J Trop Med Hyg 52 : 94–97.
  18. Marti H, Haji HJ, Savioli L, Chwaya HM, Mgeni AF, Ameir JS, Hatz C, 1996. A comparative trial of a single-dose ivermectin versus three days of albendazole for treatment of Strongyloides stercoralis and other soil-transmitted helminth infections in children. Am J Trop Med Hyg 55 : 477–481.
  19. Datry A, Hilmarsdottir I, Mayorga-Sagastume R, Lyagoubi M, Gaxotte P, Biligui S, Chodakewitz J, Neu D, Danis M, Gentilini M, 1994. Treatment of Strongyloides stercoralis infection with ivermectin compared with albendazole: results of an open stud of 60 cases. Trans R Soc Trop Med Hyg 88 : 344–345.
  20. Toma H, Sato Y, Shiroma Y, Kobayashi J, Shimabukuro I, Takara M, 2000. Comparative studies on the efficacy of three antihelminthics on treatment of human strongyloidaisis in Okinawa, Japan. Southeast Asian J Trop Med Public Health 31 : 147–151.
  21. Adedayo O, Grell G, Bellot P, 2002. Hyperinfective strongyloidiasis in the medical ward: review of 27 Cases in 5 years. South Med J 97 : 711–716.
  22. Klotz U, Ogbuokir J, Okonkwo P, 1990. Ivermectin bindings avidly to plasma proteins. Eur J Clin Pharmacol 39 : 607–608.
  23. Okonkwo P, Ogbuokiri J, Ofoegbu E, Klotz U, 1993. Protein binding and ivermectin estimations in patients with onchocerciasis. Clin Pharmacol Ther 53 : 426–430.
  24. Edwards G, 2003. Ivermectin: does P-glycoprotein play a role in neurotoxicity? Filaria J 2 : S8.
  25. Roulet A, Puel O, Gesta S, Lepage JF, Drag M, Soll M, Alvinerie M, Pineau T, 2003. MDR-1 deficient genotype in Collie dogs hypersensitive to the P-glycoprotein substrate ivermectin. Eur J Pharmacol 460 : 85–91.
  26. Kwei GY, Alvaro RF, Chen Q, Jenkins HJ, Hop CE, Keohane CA, Ly VT, Strauss JR, Wang RW, Wang Z, Pippert TR, Umbenhauer DR, 1999. Disposition of ivermectin and cyclosporin A in CF-1 mice deficient in mdr1a P-glycoprotein. Drug Metab Dispos 27 : 581–587.
  27. Rothova A, van der Lelij A, Stilma JS, Wilson WR, Barbe RF, 1989. Side-effects of ivermectin in treatment of onchocerciasis. Lancet 1 : 1439–1441.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2005.73.911
Loading
/content/journals/10.4269/ajtmh.2005.73.911
Loading

Data & Media loading...

  • Received : 01 Apr 2005
  • Accepted : 14 Jun 2005

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error