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Nematodes - hookworm

Introduction, etiology

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Infection is transmitted by eggs or larvae, which begin their cycle of development within the human host when, depending on the species, they either actively penetrate intact skin or are ingested or, very rarely, inhaled. The larvae of the most widely prevalent species remain dormant but potentially infective for long periods in contaminated soil; the larvae or cysts of other species are ingested when the flesh of reservoir hosts is eaten either raw or undercooked.

Over 1300 million people in tropical and subtropical countries are estimated (2002) to be infected with either Ancylostoma duodenale or Necator americanus, and associated anaemia causes at least 65,000 deaths annually (2002).

Recommended treatments

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mebendazole
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chewable tablet, 100 mg, 500 mg

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Adults and children over 2 years:
100 mg twice daily for 3 consecutive days
A second course may be given after 3 or 4 weeks if eggs persist in the faeces

For mass treatment control programmes:
Adult and children over 2 years:
500 mg as a single dose
or
albendazole
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chewable tablet, 400 mg

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Adults and children over 2 years:
A single dose of 400 mg
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Albendazole (400 mg) is slightly more effective than a single dose of mebendazole (500 mg)

Treatment of mixed Ascaris and hookworm infections
levamisole
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tablet, 50 mg, 150 mg (as hydrochloride)

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Adults and children over 2 years:
A single dose of 2.5 mg/kg is used widely for both individual treatment and community based campaigns.

Note: in cases of severe hookwork infection, a second standard dose may be given 7 days after the first
or, in some community based control programmes
pyrantel
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chewable tablet 250 mg (as embonate)
oral suspension, 50 mg (as embonate)/ml

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Adults and children:
A single dose of 10 mg/kg.
In case of heavy hookworm infection, 3 further doses should be given on consecutive days

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For anaemic patients: ferrous sulfate (tablet, equivalent to 60 mg iron oral solution, equivalent to 25 mg iron (as sulfate)/ml), Adults, 200 mg daily for at least 3 months after the haemoglobin concentration has regained the threshold of 12 g/100 ml

References
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Model Formulary search, enter 'hookworm' and see Intestinal nematode infections
   http://mednet3.who.int/eml/modelFormulary.asp
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Report of the WHO informal consultation on hookworm infection and anaemia in girls and women WHO/CTD/SIP/96.1
   http://www.who.int/wormcontrol/documents/publications/en/96-1.pdf
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Hookworm Infection and Anaemia - Approaches to Prevention and Control. ISBN: 92 4 154415 5
   http://whqlibdoc.who.int/publications/1991/9241544155.pdf
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Intestinal nematodes; WHO link page
   http://www.who.int/health-topics/intestinal.htm
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Hookworm, e-medicine
   http://www.emedicine.com/emerg/topic841.htm
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Hookworm Vaccine Initiative, Sabin Vaccine Institute
   http://www.sabin.org/hookworm.htm
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WHO Model Prescribing Information. Drugs used in parasitic diseases second edition, 1995. 146 pages [E, F, S] ISBN 92 4 140104 4 Sw.fr. 35.-/US $31.50. In developing countries Sw.fr.24.50.
Note: Where there is discrepancy between this book and the WHO Model Formulary, the Formulary should be considered to be the more authoritative.
  Sales Information: http://www.who.int/bookorders/index.htm
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Report of the WHO Informal Consultation on the use of praziquantel during pregnancy/lactation and albendazole/mebendazole in children under 24 months, Geneva, 8-9 April, 2002, WHO/CDS/CPE/PVC/2002.4
   http://www.who.int/wormcontrol/documents/en/pvc_20024full.pdf
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Benzimidazoles: use in children, Essential Medicines, WHO Drug Information, Vol 17, No. 1, 2003
   http://www.who.int/druginformation/vol17num1_2003/vol17-1.pdf

Model Formulary search