Trophozoites or cysts on stool micro (cannot distinguish between cysts of E histolytica or E. dispar)

May be associated with GIT symptoms

FBE/differential

Ferritin

Fresh stool <24 h for ELISA or PCR(if available). If this confirms E dispar, do nothing. If confirms E histolytica, treat.

If ELISA/PCR not available, serology (IHA) for E. histolytica, although baseline positive 30% in endiic areas.

Asymptomatic: eliminate intraluminal carriage

Diloxanide 20 mg/kg/day (max 500 mg/dose) in 3 divided doses oral 10 days

Paramomycin 10 mg/kg/dose 8 hourly oral 7 days (SAS medication)

Symptomatic: Discuss with ID. Metronidazole 15 mg/kg/dose (max 750 mg) tds oral 7-10 days followed by luminal agent (as above)

Ova on stool micro

History of worms

May be a/w respiratory Sx

FBE/differential

Ferritin

Albendazole (weight > 10 kg) 400 mg oral stat (200 mg for patient over 6 months, up to 10 kg)

Mebendazole 100 mg oral bd 3 days

Trophozoites or cysts on stool micro

May be associated with GIT symptoms

FBE/differential

Ferritin

Metronidazole 30 mg/kg/dose oral (max 2 g) daily for 3 days

Tinidazole 50 mg/kg stat dose oral (max 2 g)

FBE/differential

Ferritin

Albendazole (weight > 10 kg) 400 mg oral stat (200 mg for patient over 6 months, up to 10 kg)

Mebendazole 100 mg oral bd 3 d

byloides serology

FBE/differential

Ferritin

Ivermectin (weight >15 kg) 200 mcg/kg dose x 2 doses, day 1 and day 14 (2 weeks apart)

Albendazole (weight > 10 kg) 400 mg oral twice daily for 7 days

(200 mg for patient over 6 months, up to 10 kg) – less effective than ivermectin

If larvae on stool micro then repeat 3 days post treatment

Serology & FBE at 6 months

If parasites persist on stool micro repeat Rx at 2 weeks

If serum IgG and eosinophilia persist at 3-6 months

Children < 5 years may require monitoring and treatment with ivermectin once they are 5 years.

Fresh stool micro

FBE/diff/Ferritin

Schistosoma spp.
(Bilharzia)

also see Schistosomiasis guideline

FBE/differential

Schistosoma serology

Praziquantel

• 20 mg/kg/dose x 2 doses orally - 4 hrs apart (no upper limit)
• 40 mg/kg total may be given as a single stat dose in children

Stool/urine micro (x 3 specimens) at 3-6 months. Serology at 6 & 12 months

FBE/diff at 3 months

Persistent parasite, increasing IgG titre 6/12 post Rx (esp if eosinophillia)

IgG same at 12mo

Clear positive IgG and negative stool micro

Midday end urine micro for ova (lab x5738 first)

Renal/bladder US if symptoms

Proglottids or ova in faeces

Nodules

Check for neurological Sx (different Rx)

FBE/differential

Ferritin

Praziquantel 10 mg/kg/dose stat oral

Rodentolepis nana (prev. Hymenolepis nana; dwarf tapeworm) requires Praziquantal 25 mg/kg/dose stat oral

Ova stool micro

May be assoc. with bloody diarrhoea, pain

FBE/differential

Ferritin

Mebendazole 100 mg oral bd 3 days

(200 mg for patient over 6 months, up to 10 kg)

Note:

1. The safety of Praziquantel in children <2 yrs has not been established - Discuss with ID
2. Albendazole tabs are chewable and soluble and trials include children 2 years and over. There is limited data on use in children aged > 6 months. Discuss if liver disease
3. Ivermectin is used in children >15 kg
4. Exclude pregnancy in adolescents; Praziquantal B1, Metronidazole B2, Ivermectin B3, Albendazole D.