Ivermectin versus benzimidazoles for treating Strongyloides stercoralis infection

Cesar Henriquez-Camacho1,2, Eduardo Gotuzzo1,3, Juan Echevarria1, A Clinton White Jr1,4, Angelica Terashima1,3, Frine Samalvides1, José A Pérez-Molina5, Maria N Plana6

1. Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru
2. Hospital Universitario Fundación Alcorcón, Internal Medicine, Madrid, Spain
3. Hospital Nacional Cayetano Heredia, Lima, Peru
4. University of Texas Medical Branch, Department of Internal Medicine, Galveston, USA
5. Hospital Ramón y Cajal, Tropical Medicine and Parasitology Unit, Infectious Disease Service, Madrid, Spain
6. Clinical Biostatistics Unit. Ramón y Cajal Hospital (IRYCIS). Francisco de Vitoria University (UFV Madrid). CIBER Epidemiology and Public Health (CIBERESP), Cochrane Collaborating Centre, Madrid, Spain

Henriquez-Camacho C, Gotuzzo E, Echevarria J, White Jr AC, Terashima A, Samalvides F, Pérez-Molina JA, Plana MN. Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD007745. DOI: 10.1002/14651858.CD007745.pub3

Access the full-text article here: DOI: 10.1002/14651858.CD007745.pub3

What is strongyloides infection and how might ivermectin work

Strongyloides stercoralis is a parasite that lives in the gut of infected people. The infection is not serious for most people, but it can be fatal in people with immune deficiency. People become infected when they come in contact with soil or water contaminated with infectious worms. The chronic infection usually causes skin rash, vomiting, diarrhoea, and constipation, and respiratory problems, such as asthma-like illness. This disease may be treated with ivermectin or albendazole or thiabendazole. We wanted to know if ivermectin was better or worse than the other alternative therapies.

What the research says

We reviewed the evidence about the effect of ivermectin compared with albendazole and thiabendazole. After searching for relevant trials up to August 2015, we included seven randomized controlled trials, enrolling 1147 adults with chronic strongyloides infection, conducted between 1994 and 2011 in different locations (Africa, Southeast Asia, America, and Europe). Four trials assessed the effectiveness of ivermectin compared with albendazole and three trials assessed the effectiveness of ivermectin compared with thiabendazole.

Comparison ivermectin versus albendazole

Treatment with ivermectin probably cures more people than albendazole (moderate quality evidence), and may be equally or better tolerated (low quality evidence). The included trials did not report serious adverse events or death.

Comparison ivermectin versus thiabendazole

Treatment with ivermectin and thiabendazole may cure similar numbers of people with strongyloides infection (low quality evidence), but ivermectin is probably better tolerated (moderate quality evidence). The included trials did not report serious adverse events or death.