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Failure of Ivermectin per Rectum to Achieve Clinically Meaningful Serum Levels in Two Cases of Strongyloides Hyperinfection

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  • Division of General Internal Medicine, University Health Network, Toronto, Canada; Division of Infectious Diseases, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada; Department of Pharmacy, St. Michael's Hospital, Toronto, Canada; Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, Iowa
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Two cases of Strongyloides hyperinfection are presented. Ivermectin was initially administered orally and per rectum pending the availability of subcutaneous (SC) preparations. In neither case did rectal suppositories of ivermectin achieve clinically meaningful serum values. Clinicians should use SC preparations of ivermectin as early as possible in Strongyloides hyperinfection and dissemination.

Author Notes

* Address correspondence to Isaac I. Bogoch, Divisions of Internal Medicine and Infectious Diseases, Toronto General Hospital, 200 Elizabeth Street, 14EN-209, Toronto, Ontario, Canada M5G 2C4. E-mail: isaac.bogoch@uhn.ca

Authors' addresses: Isaac I. Bogoch, Divisions of Internal Medicine and Infectious Diseases, Toronto General Hospital, Toronto, Ontario, Canada, E-mail: isaac.bogoch@uhn.ca. Kamran Khan, Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada, E-mail: khank@smh.ca. Howard Abrams, Division of General Internal Medicine, University Health Network, Toronto, Canada, E-mail: howard.abrams@uhn.ca. Caroline Nott, Department of Medicine, University of Toronto, Toronto, Canada, E-mail: carolinenott02@hotmail.com. Elizabeth Leung, Department of Pharmacy, St. Michael's Hospital, Toronto, Canada, E-mail: leungeli@smh.ca. Lawrence Fleckenstein, Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, IA, E-mail: l-fleckenstein@uiowa.edu. Jay S. Keystone, Division of Infectious Diseases, University Health Network, Toronto, Canada, E-mail: jay.keystone@toronto.ca.

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