Non-oral treatment with ivermectin for disseminated strongyloidiasis

Abstract

Critically ill patients with disseminated strongyloidiasis may not be candidates for oral treatment. We report four patients with disseminated strongyloidiasis, believed to be unable to absorb oral therapy, who were treated with ivermectin by rectal and/or subcutaneous administration. Obtaining subcutaneous ivermectin and dosing it appropriately is a challenge. These cases underscore the need for improved access to subcutaneous ivermectin and more pharmacological data to guide use of this treatment approach.

Figure 1.

Data for patient 4. A, Plasma and respiratory ivermectin trough levels (ng/mL). X = doses of subcutaneous ivermectin; r = doses of rectal ivermectin. Respiratory levels were obtained from tracheal aspirates. B, Stool and respiratory parasite burdens. 0 = none; 1 = sparse; 2 = moderate; 3 = many. Respiratory samples included bronchoalveolar fluid on days 11 and 20; tracheal aspirate on days 14, 18, 19, 25, and 27; and sputum on day 23.