Re: ICU: Vermox info please PS FROM HERNE

Mebendazole (Vermox) product monograph:

http://www.medscape.com/druginfo/monograph?cid=med&drugid=7087&drugname=Vermo...



Monograph - Mebendazole
Class: ANTHELMINTICS(8:08)

Sections: Uses | Dosage and Administration | Cautions | Drug Interactions | Acute Toxicity | Mechanism of Action | Spectrum | Pharmacokinetics | Chemistry and Stability | Preparations



Mebendazole is a synthetic anthelmintic agent. The drug is a benzimidazole derivative structurally related to albendazole and thiabendazole.


Uses



Mebendazole is used for the treatment of a variety of nematode (roundworm) infections, including trichuriasis (whipworm infection) caused by Trichuris trichiura, enterobiasis (pinworm infection) caused by Enterobius vermicularis, ascariasis (roundworm infection) caused by Ascaris lumbricoides, and hookworm infections caused by Ancylostoma duodenale, Necator americanus, or Ancylostoma caninum. The drug’s broad spectrum of activity makes it useful in the treatment of mixed helminthic infections. Mebendazole has produced egg reduction percentages and/or cure rates of over 90% in patients with enterobiasis, ascariasis, or hookworm infection caused by A. duodenale or N. americanus and has produced egg reduction percentages of over 90% and cure rates of approximately 70% in patients with trichuriasis. The efficacy of mebendazole in the treatment of helminthic infections varies in patients as a function of preexisting diarrhea, GI transit time, degree of infection, and helminth strain; cure rates are usually lower than average in patients who have massive infections and in patients with hypermotility of the GI tract.
Although other anthelmintics (e.g., praziquantel, albendazole, or nitazoxanide) usually are recommended for the treatment of infections caused by cestodes (tapeworms), mebendazole has been used for the treatment of intestinal infections caused by the adult forms of certain tapeworms, including Hymenolepis nana† (dwarf tapeworm), Taenia saginata† (beef tapeworm), and T. solium† (pork tapeworm), and for the treatment of hydatid disease caused by the larval form of Echinococcus granulosus† (dog tapeworm).

•Nematode (Roundworm) Infections

Ascariasis

Mebendazole is used for the treatment of ascariasis caused by Ascaris lumbricoides. Albendazole, ivermectin, and mebendazole are considered the drugs of choice for the treatment of ascariasis.

Enterobiasis
Mebendazole is used for the treatment of enterobiasis caused by Enterobius vermicularis (pinworm). Albendazole, mebendazole, and pyrantel pamoate are considered the drugs of choice for the treatment of enterobiasis.

Filariasis
Mansonella perstans Infections.

Mebendazole or albendazole are considered the drugs of choice for the treatment of filariasis caused by Mansonella perstans†. Use of antihistamines or corticosteroids may be indicated to decrease allergic reactions secondary to disintegration of microfilariae following treatment of filarial infections.
Onchocerciasis.

Mebendazole also has been used for the treatment of onchocerciasis† (filariasis caused by Onchocerca volvulus), but ivermectin usually is considered the drug of choice for this infection. Other anthelmintics (usually diethylcarbamazine [available in the US from the US Centers for Disease Control and Prevention]) are recommended for the treatment of infections caused by most other filarial worms.


Hookworm Infections
Intestinal Hookworm Infections.

Mebendazole is used for the treatment of intestinal hookworm infections caused by Ancylostoma duodenale or Necator americanus in single or mixed infections. Albendazole, mebendazole, or pyrantel pamoate are considered the drugs of choice for intestinal hookworm infections.
Eosinophilic Enterocolitis Caused by Ancylostoma caninum.

Mebendazole, albendazole, pyrantel pamoate, or endoscopic removal of worms is recommended for the treatment of eosinophilic enterocolitis† caused by Ancylostoma caninum (dog hookworm).


Toxocariasis (Visceral Larva Migrans)
Mebendazole is used for the treatment of toxocariasis† (visceral larva migrans) caused by Toxocara canis or T. cati (dog and cat roundworms), and albendazole or mebendazole are considered the drugs of choice for these infections. In severe cases with cardiac, ocular, or CNS involvement, corticosteroids also may be indicated. Treatment may not be effective in ocular larva migrans; inflammation may be reduced by corticosteroid injections and surgery may be necessary for secondary damage.

Trichinellosis
Mebendazole is used for the treatment of trichinellosis† (trichinosis) caused by Trichinella spiralis. Although some clinicians state that albendazole and mebendazole are equally effective for the treatment of trichinosis, other clinicians consider mebendazole the drug of choice and albendazole the alternative, particularly during the tissue phase of the illness. Use of corticosteroids in addition to the anthelmintic usually is recommended, especially when symptoms are severe. Corticosteroids alleviate symptoms of the inflammatory reaction and can be lifesaving when cardiac or CNS systems are involved.

Trichostrongyliasis
Mebendazole is used in the treatment of infections caused by trichostrongyliasis†. Pyrantel pamoate is considered the drug of choice for the treatment of Trichostrongylus infections and albendazole and mebendazole are alternatives.

Trichuriasis
Mebendazole is used for the treatment of trichuriasis caused by Trichuris trichiura (whipworm). Mebendazole is the drug of choice and albendazole and ivermectin, are alternatives for the treatment of trichuriasis.

Other Nematode Infections
Mebendazole used in conjunction with corticosteroids appeared to shorten the course of infection (but not the number of relapses) in several patients with eosinophilic meningitis caused by Angiostrongylus cantonensis†. Most patients experience a self-limited course of infection with complete recovery. No drug has been shown to be effective in the treatment of this infection and some patients have worsened when treated.
Mebendazole is considered the drug of choice and albendazole is an alternative for the treatment of capillariasis† caused by Capillaria philippinensis.

Mebendazole has been used in the treatment of Dracunculus medinensis† (guinea worm) infection; the drug has been reported to kill the worm directly. Slow extraction of the worm and wound care is recommended by some clinicians as the treatment of choice. Metronidazole therapy is not curative, but decreases inflammation and facilitates removal of the worm.


•Cestode (Tapeworm) Infections

Mebendazole has been used in the treatment of intestinal infections caused by the adult forms of certain tapeworms, including Hymenolepis nana† (dwarf tapeworm), Taenia saginata† (beef tapeworm), and T. solium† (pork tapeworm). However, other anthelmintics (usually praziquantel or nitazoxanide) are recommended for the treatment of intestinal infections caused by adult forms of these cestodes.
Mebendazole has been effective in a limited number of patients for the treatment of hydatid disease caused by the larval form of Echinococcus granulosus† (dog tapeworm). The manufacturers state that there is no evidence that mebendazole, even at high doses, is effective for the treatment of hydatid disease. Surgery is considered the treatment of choice for hydatid disease, when medically feasible, but perioperative administration of an anthelmintic drug may be indicated in patients undergoing surgical removal of cysts to minimize the risk of intraoperative dissemination of daughter cysts.

Mebendazole has been used for the treatment of alveolar hydatid disease caused by E. multiocularis† in a very limited number of patients; however, surgical excision of the larval mass is the recommended and only reliable treatment for these infections. Continuous albendazole or mebendazole therapy reportedly has been associated with clinical improvement in nonresectable cases.

•Giardiasis

Although metronidazole, tinidazole, or nitazoxanide generally are considered the drugs of choice for the treatment of giardiasis caused by Giardia duodenalis (also known as G. lamblia or G. intestinalis), mebendazole has been used for the treatment giardiasis† in a limited number of adolescents and children.