Albendazole (Zentel) listing extended to treat hookworm and strongyloidiasis

Both hookworms and Strongyloides stercoralis infect humans via larvae that penetrate the skin, are carried by the blood to the lungs, then migrate to the small intestine via the trachea and oesophagus. There they become adults and attach themselves to the intestinal wall to feed and lay eggs.2,6,7

Adult hookworms can live in the human body for up to 5–7 years but they are unable to reproduce solely within a human host.6 Instead eggs are excreted in faeces, hatch in contaminated soil and then develop into larvae that can infect another person.7

In contrast, without adequate treatment S. stercoralis infection may be lifelong due to auto-infection. S. stercoralis larvae hatch from eggs while still in the intestinal tract. Some of these newly hatched larvae reinfect the host and repeat the cycle, while others are passed in the faeces. Excreted larvae can infect other people or develop into free-living adults that continue laying eggs.2

Strongyloidiasis and light hookworm infections are often asymptomatic. However, local itching and rash may occur where larvae penetrate the skin, and respiratory symptoms may occur when larvae migrate into the lungs.2,7

In heavy hookworm infections, blood loss where adult hookworms attach themselves to the intestinal wall can cause anaemia.6 Other symptoms may include abdominal pain, diarrhoea, loss of appetite, weight loss, and stunted growth and mental development.7

Auto-infective S. stercoralis larvae can disseminate throughout the body and may carry intestinal bacteria to other parts of the body.2,8 Disseminated disease is potentially fatal and poses the greatest risk to people who are immunocompromised or taking corticosteroids.8 People with disseminated disease may present with abdominal pain, distension, shock, pulmonary and neurological complications and septicaemia.2

Use a single dose of albendazole to treat hookworm. Albendazole is less effective than ivermectin in treating strongyloidiasis and should be reserved for those in whom ivermectin is not recommended (Table 1).3,9

Ivermectin is not recommended in children < 5 years because of a lack of data.11 Refer young children with strongyloidiasis to a paediatrician or infectious-disease specialist.3 In remote areas where access to a specialist may be difficult, albendazole may be given.5 Use 200 mg once daily for 3 days if the child is < 10 kg, and 400 mg once daily for 3 days if the child is > 10 kg. Take on an empty stomach to increase intestinal absorption and repeat after 1 week.4,9

Ivermectin should not be used in people who also have Loa loa (loiasis), as there is a risk of severe encephalopathy or death in these patients.3,11 Use serology to rule out L. loa in people from West and Central Africa (where it is endemic) or in people who report episodic subcutaneous swellings or an 'eye-worm'.3 Refer people with loiasis to an infectious-disease specialist.3

Albendazole should not be used in pregnancy or in children aged < 6 months.9,12 The manufacturer recommends discontinuing breastfeeding during, and for 5 days after, treatment.12

The most common adverse effect is abdominal pain, reported by 1% of trial participants. Other less common side effects include diarrhoea, nausea, headache, dizziness and skin rashes.9,12

Medicare Benefits Schedule (MBS) item numbers 714 and 716 reimburse general practitioners who perform refugee and humanitarian entrant health assessments within 12 months of the patient's arrival in Australia.

Refugee health assessments should always be undertaken with an appropriate interpreter, preferably someone who is not known to the patient personally.3 The Telephone Interpreting Service (TIS) is available free of charge to general practitioners who provide a Medicare service to non-English speaking permanent residents or Australian citizens. Call the TIS Doctors' Priority Line (1300 131 450) to access this service.13