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

PHILIP E. TARR 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

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PETER S. MIELE 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

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KENNETH S. PEREGOY 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

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MARGO A. SMITH 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

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FRANKLIN A. NEVA 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

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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

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DOI:
https://doi.org/10.4269/ajtmh.2003.68.453
Volume/Issue:
Volume 68: Issue 4
Page(s):
453–455
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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.

Author Notes

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@yahoo.com
Copyright:
Copyright 2003 The American Society of Tropical Medicine 2003
Received:
20 Sep 2002
|
Accepted:
06 Nov 2002
|
Published Online:
Apr 2003
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
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