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Whipworm: Treatment and Medication

Authors: Robert W. Tolan, Jr, MDAuthor Information and Disclosures

Contents

Treatment

Medical Care: Infections are treated with broad-spectrum anthelminthic agents. Most infections can be treated successfully with mebendazole. Retreatment is occasionally necessary if symptoms persist longer than 2 weeks after initial treatment.

Consultations: Consultations with the following specialists may be appropriate:

  • Infectious disease specialist
  • Gastroenterologist
  • Hematologist

Medication

Drug Category: Anthelmintics -- Parasite biochemical pathways are different from the human host; thus, toxicity is directed to the parasite, egg, or larvae. Mebendazole is the treatment of choice for trichuriasis. Albendazole is an alternative medication that can be used. Both are broad-spectrum anthelminthic agents. These drugs interfere with the organism's microtubule formation. Recently, nitazoxanide has been studied as a possible treatment option.

Mebendazole (Vermox) -- The treatment of choice for whipworm infections. Causes worm death by selectively and irreversibly blocking uptake of glucose and other nutrients in adult intestine where helminths dwell.
Adult Dose100 mg PO bid for 3 d or 500 mg PO once
Pediatric Dose<2 years: Not established
>2 years: Administer as in adults
ContraindicationsDocumented hypersensitivity
InteractionsCarbamazepine and phenytoin may decrease effects of mebendazole; cimetidine may increase mebendazole levels
Pregnancy C - Safety for use during pregnancy has not been established.
PrecautionsAdjust dose in hepatic impairment; use caution when breastfeeding because extent of drug excretion is not known; use caution in patients <2 y because limited data exist

Albendazole (Albenza) -- Decreases ATP production in worms, causing energy depletion, immobilization, and, finally, death. Considered investigational for use in treating this condition.
Adult Dose400 mg PO as a single dose for 1 d, 3-d treatment often required for heavy infestations; may repeat in 3 wk prn
Pediatric Dose<2 years: 200 mg PO qd for 3 d; repeat in 3 wk prn
>2 years: Administer as in adults
ContraindicationsDocumented hypersensitivity
InteractionsCoadministration with carbamazepine may decrease efficacy; dexamethasone, cimetidine, and praziquantel may increase toxicity; abdominal pain, nausea, vomiting, diarrhea, dizziness, vertigo, fever, increased intracranial pressure, and alopecia may occur
Pregnancy C - Safety for use during pregnancy has not been established.
PrecautionsDiscontinue use if serum transaminases increase significantly (resume when levels decrease to pretreatment values)

Nitazoxanide (Alinia) -- Inhibits growth of Cryptosporidium parvum sporozoites and oocysts and Giardia lamblia trophozoites. Elicits antiprotozoal activity by interfering with pyruvate-ferredoxin oxidoreductase (PFOR) enzyme-dependent electron transfer reaction, which is essential to anaerobic energy metabolism. Available as a 20-mg/mL oral susp. May have activity in trichuriasis.
Adult Dose500 mg PO bid for 3 d
Pediatric Dose<1 year: Not established
1-3 years: 100 mg (5 mL) PO q12h for 3 d with food
4-11 years: 200 mg (10 mL) PO q12h for 3 d with food
>11 years: Administer as in adults
ContraindicationsDocumented hypersensitivity
InteractionsTizoxanide (nitazoxanide metabolite) is >99.9% bound to plasma protein and may potentially increase toxicity of other highly plasma protein-bound drugs
Pregnancy C - Safety for use during pregnancy has not been established.
PrecautionsMay cause abdominal pain, diarrhea, vomiting, or headache; administer with food; caution when coadministered with other highly plasma protein-bound drugs with narrow therapeutic indices

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Synonyms And Related Keywords

Nematoda, parasite, parasite infection, parasitic disease, trichuriasis, Trichuris trichiura, T trichiura, whipworm, rectal prolapse, Trichuris dysentery syndrome, ascaris, anemia

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Author Information and Disclosures

Author: Robert W. Tolan, Jr, MD, Chief of Allergy, Immunology and Infectious Diseases, The Children's Hospital at St Peter's University Hospital, Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Coauthor(s): Tina Slusher, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Critical Care, West Virginia University; Steven L. Lanski, MD, Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University and Children's Healthcare of Atlanta at Egleston

Robert W. Tolan, Jr, MD, is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Disease Society, Phi Beta Kappa, and Physicians for Social Responsibility

Editor Information

Editor(s): Ashir Kumar, MBBS, MD, FAAP, Professor, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University; Consulting Staff, Department of Pediatrics, EW Sparrow Hospital; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc; Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University; Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine; and Russell W Steele, MD, Professor and Vice Chairman, Department of Pediatrics, Head, Division of Infectious Diseases, Louisiana State University Health Sciences Center

 
 
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