Loefflers syndrome medical therapy: Difference between revisions
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{{Loefflers syndrome }} | {{Loefflers syndrome }} | ||
{{CMG}} | {{CMG}} {{AE}}{{Soroush}} | ||
==Overview== | ==Overview== | ||
The majority of cases of Löffler syndrome are self-limited and require only supportive care. Nevertheless, pharmacologic medical therapy is recommended among patients with parasitic infections and hence, appropriate use of [[Anthelmintic|anthelmintic drugs]] is warranted. Additionally, patients with sever symptoms are treated with [[Corticosteroid|corticosteroids]]. [[Anti inflammatory medications|Anti-inflammatory]] effects of [[Corticosteroid|corticosteroids]], reverse increased capillary permeability and suppress [[Neutrophil|PMN]] activity. [[Corticosteroid]]<nowiki/>s such as [[prednisone]] decrease [[Interleukin 5|interleukin-5]], and [[granulocyte macrophage colony stimulating factor]], and hence decrease eosinophil survival. | |||
==Medical Therapy== | ==Medical Therapy== | ||
*The majority of cases of Löffler syndrome are self-limited and require only supportive care. | |||
*Nevertheless, pharmacologic medical therapy is recommended among patients with parasitic infections and hence, appropriate use of [[Anthelmintic|anthelmintic drugs]] is warranted. | |||
*Additionally, patients with sever symptoms are treated with [[Corticosteroid|corticosteroids]]. | |||
*[[Anti inflammatory medications|Anti-inflammatory]] effects of [[Corticosteroid|corticosteroids]], reverse increased capillary permeability and suppress [[Neutrophil|PMN]] activity. [[Corticosteroid|Co]]<nowiki/>[[Corticosteroid|rticosteroid]]<nowiki/>s such as [[prednisone]] decrease [[Interleukin 5|interleukin-5]], and [[granulocyte macrophage colony stimulating factor|granulocyte macrophage colony stimul]]<nowiki/>[[granulocyte macrophage colony stimulating factor|ating factor]], and hence decrease eosinophil survival. | |||
===Corticosteroid therapy=== | |||
:*Only indicated in sever cases | |||
:*There is no guideline for [[corticosteroid]] therapy of pat<nowiki/>ient with Lö<nowiki/>ffler syndrome | |||
:*Decision <nowiki/>making and dosage dete<nowiki/>rmination is<nowiki/> case based with respect<nowiki/> to the presentation of the<nowiki/> patient. | |||
:*In sever<nowiki/> cases, sugg<nowiki/><nowiki/>ested starting dose is 1 mg/kg/day of prednisone or equivalent with slow tapering ove<nowiki/>r 6–8 week<nowiki/>s | |||
===Strongyloidiasis=== | |||
:* '''Preferred regimen''' '''(1):''' | |||
:* [[Ivermectin|Iver]]<nowiki/>[[Ivermectin|mectin]] 200 μg/kg/day PO q<nowiki/>24h for 2 days.<ref name="pmid8483992">{{cite journal| author=Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR| title=Albendazole is effective treatment for chronic strongyloidiasis. | journal=Q J Med | year= 1993 | volume= 86 | issue= 3 | pages= 191-5 | pmid=8483992 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8483992 }} </ref><ref>{{Cite web | title = WGO Practice Guideline Management of Strongyloidiasis| url = http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/15_management_strongyloidiasis_en.pdf}}</ref> | |||
:** Note: For [[immunocompromised]] patients, several treatment c<nowiki/>ourses at 2-week intervals is recommended. | |||
:* '''Alternative regimen (1):''' | |||
:* [[Thiabendazole]] 1.5 g PO q24h for 2 consecutive days. | |||
:** Note: The maximum dosage is 3 g/d every 2 days (this dosage is likely to be toxic and needs to be reduced) | |||
:** Note: Cure rates are as high <nowiki/>as 8<nowiki/>7% t<nowiki/>o 94<nowiki/>%, but the drug may not be effective in the disease that is disseminated beyond the [[gastrointestinal tract]]. | |||
:** Note: Many patients have [[gastrointestinal]] adverse effects, it is used rarely in the U.S. because of adverse effects | |||
:* '''Alternative regimen (2):''' | |||
:* [[Albendazole]] 400 mg PO bid for 3 days | |||
===Ascariasis=== | |||
* '''Preferred regimen:''' | |||
:* [[Albendazole]] 400 mg PO single dose. [[Albendazole]] dose for children between the ages of 1-2 years is 200 mg. | |||
:* [[Mebendazole]] 500 mg PO single dose or 100 mg bid for 3 days | |||
* | * '''Alternative regimen''' | ||
:* [[Ivermectin]] 150 to 200 µg/kg PO single dose | |||
:* [[Nitazoxanide]] 500 mg bid for 3 days (adolescents and adults); 200mg bid for 3 days (children 4-11 yrs of age); 100mg PO bid for 3 days (children 1-3 yrs of age) | |||
:* [[Levamisole]] 150 mg PO single dose. The pediatric dose is 2.5 mg/kg PO daily | |||
:* [[Pyrantel pamoate]] 11 mg/kg single dose PO, maximum 1.0 g | |||
:* [[Piperazine citrate]] 75 mg/kg/day for 2 days, maximum 3.5 g/day<ref name="Principles and Practice">Durand, Marlene (2015). "Chapter 288:Intestinal Nematodes (Roundworms)". Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition. Elsevier. pp. 3199–3207. ISBN 978-1-4557-4801-3.</ref><ref name="cdc1">Centers for Disease Control and Prevention.https://www.cdc.gov/parasites/ascariasis/health_professionals/index.html#tx Accessed on the 6th of March, 2017.</ref><ref name="pmid9580117">{{cite journal| author=Romero Cabello R, Guerrero LR, Muñóz García MR, Geyne Cruz A| title=Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico. | journal=Trans R Soc Trop Med Hyg | year= 1997 | volume= 91 | issue= 6 | pages= 701-3 | pmid=9580117 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9580117 }} </ref><ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040 }} </ref><ref name="Nelson Textbook of Pediatrics">Kliegman, Robert; Stanton, Bonita; St. Geme, Joseph; Schor, Nina (2016). "Chapter 291:Ascariasis (Ascaris lumbricoides)". Nelson Textbook of Pediatrics Twentieth Edition. Elsevier. pp. 1733–1734. ISBN 978-1-4557-7566-8.</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Immunology]] | [[Category:Immunology]] | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
Latest revision as of 19:49, 6 June 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]
Overview
The majority of cases of Löffler syndrome are self-limited and require only supportive care. Nevertheless, pharmacologic medical therapy is recommended among patients with parasitic infections and hence, appropriate use of anthelmintic drugs is warranted. Additionally, patients with sever symptoms are treated with corticosteroids. Anti-inflammatory effects of corticosteroids, reverse increased capillary permeability and suppress PMN activity. Corticosteroids such as prednisone decrease interleukin-5, and granulocyte macrophage colony stimulating factor, and hence decrease eosinophil survival.
Medical Therapy
- The majority of cases of Löffler syndrome are self-limited and require only supportive care.
- Nevertheless, pharmacologic medical therapy is recommended among patients with parasitic infections and hence, appropriate use of anthelmintic drugs is warranted.
- Additionally, patients with sever symptoms are treated with corticosteroids.
- Anti-inflammatory effects of corticosteroids, reverse increased capillary permeability and suppress PMN activity. Corticosteroids such as prednisone decrease interleukin-5, and granulocyte macrophage colony stimulating factor, and hence decrease eosinophil survival.
Corticosteroid therapy
- Only indicated in sever cases
- There is no guideline for corticosteroid therapy of patient with Löffler syndrome
- Decision making and dosage determination is case based with respect to the presentation of the patient.
- In sever cases, suggested starting dose is 1 mg/kg/day of prednisone or equivalent with slow tapering over 6–8 weeks
Strongyloidiasis
- Preferred regimen (1):
- Ivermectin 200 μg/kg/day PO q24h for 2 days.[1][2]
- Note: For immunocompromised patients, several treatment courses at 2-week intervals is recommended.
- Alternative regimen (1):
- Thiabendazole 1.5 g PO q24h for 2 consecutive days.
- Note: The maximum dosage is 3 g/d every 2 days (this dosage is likely to be toxic and needs to be reduced)
- Note: Cure rates are as high as 87% to 94%, but the drug may not be effective in the disease that is disseminated beyond the gastrointestinal tract.
- Note: Many patients have gastrointestinal adverse effects, it is used rarely in the U.S. because of adverse effects
- Alternative regimen (2):
- Albendazole 400 mg PO bid for 3 days
Ascariasis
- Preferred regimen:
- Albendazole 400 mg PO single dose. Albendazole dose for children between the ages of 1-2 years is 200 mg.
- Mebendazole 500 mg PO single dose or 100 mg bid for 3 days
- Alternative regimen
- Ivermectin 150 to 200 µg/kg PO single dose
- Nitazoxanide 500 mg bid for 3 days (adolescents and adults); 200mg bid for 3 days (children 4-11 yrs of age); 100mg PO bid for 3 days (children 1-3 yrs of age)
- Levamisole 150 mg PO single dose. The pediatric dose is 2.5 mg/kg PO daily
- Pyrantel pamoate 11 mg/kg single dose PO, maximum 1.0 g
- Piperazine citrate 75 mg/kg/day for 2 days, maximum 3.5 g/day[3][4][5][6][7]
References
- ↑ Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR (1993). "Albendazole is effective treatment for chronic strongyloidiasis". Q J Med. 86 (3): 191–5. PMID 8483992.
- ↑ "WGO Practice Guideline Management of Strongyloidiasis" (PDF).
- ↑ Durand, Marlene (2015). "Chapter 288:Intestinal Nematodes (Roundworms)". Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition. Elsevier. pp. 3199–3207. ISBN 978-1-4557-4801-3.
- ↑ Centers for Disease Control and Prevention.https://www.cdc.gov/parasites/ascariasis/health_professionals/index.html#tx Accessed on the 6th of March, 2017.
- ↑ Romero Cabello R, Guerrero LR, Muñóz García MR, Geyne Cruz A (1997). "Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico". Trans R Soc Trop Med Hyg. 91 (6): 701–3. PMID 9580117.
- ↑ Khuroo MS (1996). "Ascariasis". Gastroenterol Clin North Am. 25 (3): 553–77. PMID 8863040.
- ↑ Kliegman, Robert; Stanton, Bonita; St. Geme, Joseph; Schor, Nina (2016). "Chapter 291:Ascariasis (Ascaris lumbricoides)". Nelson Textbook of Pediatrics Twentieth Edition. Elsevier. pp. 1733–1734. ISBN 978-1-4557-7566-8.