Anti-helminthic (anti-parasitic): Anti-helminthic drugs are used to kill parasites that have entered the body. They may be taken by mouth, applied to the skin, or injected into the vein. Treatment varies, depending on the type and severity of the infection.
The most commonly prescribed medication to treat ascariasis includes mebendazole (Vermox®), albendazole (Albenza®), and pyrantel (Antiminth® or Pin-Rid®).
Hookworm is generally treated with the drug mebendazole (Vermox®). According to researchers, mebendazole cures more than 99% of hookworm infections if it is taken twice a day for three days. It kills both the worms and the eggs. Albendazole (Albenza®) or pyrantel (Antiminth®) may be taken as alternatives. These drugs are taken once per day for three days.
Loiasis is typically treated with diethylcarbamazine (Hetrazan®) or ivermectin (Stromectol®).
Patients with threadworm infections typically take ivermectin (Stromectol®), thiabendazole (Mintezol®), or albendazole (Albenza®) by mouth for two to seven days. Ivermectin is considered the standard treatment because it has fewer side effects than the other drugs. These drugs work by preventing new eggs and larvae from developing.
Lymphatic filariasis may be treated with either albendazole (Albenza®) or diethylcarbamazine (Hetrazan®).
Patients with river blindness (onchocerciasis) typically take ivermectin (Stromectol®). Treatment may need to be repeated once or twice a year because the drug only kills the immature worms, not the adult worms, which can live for many years.
Trichinosis is generally treated with albendazole (Albenza®) or mebandazole (Vermox®) to kill the adult worms and larvae. Depending on how severe the infection is, some patients may need to take repeat doses to completely eliminate the worms.
Patients with whipworm infections typically taken mebendazole (Vermox®) by mouth for about three days. Albendazole (Albenza® is used as an alternative therapy for whipworm infections.
Antimalarials: Malaria is treated with a combination of antimalarials, which may include chloroquine (Aralen®), quinine, hydroxychloroquine (Plaquenil®), mefloquine (Lariam®), doxycycline (Doryx® or Vibramycin®), sulfadoxine/pyrimethamine (Fansidar®), or atovaquone/proguanil (Malarone®). Treatment usually lasts about three days.
Antimony-containing compounds: Drugs that contain antimony, which is an anti-parasitic, are often used to treat leishmaniasis. Examples of antimony-containing medications include meglumine antimonite and sodium stibogluconate.
Scabicide: Drugs called scabicides are used to treat scabies. Many skin lotions or creams, such as Lindane, permethrin (Acticin® or Elimite®), or crotamiton (Eurax Cream® or Eurax Lotion®), are applied to the skin from the neck down to kill the parasitic eggs. Treatment lasts for seven days to ensure that all the eggs are killed. Itching often lasts for about one week after treatment ends. Family members, sexual contacts, and others who have had skin-to-skin contact with a person diagnosed with scabies should also be treated.
Antifungals: Patients who have severe cases of histoplasmosis, including disseminated histoplasmosis, usually receive treatment with an intravenous antifungal medication called amphotericin B (Amphocin® or Fungizone®). Since the drug may be toxic to the kidney, it is generally injected into the patient's vein. After a few days to weeks of treatment, doctors usually switch to a drug called itraconazole (Diflucan®, Nizoral®, or Sporanox®). HIV/AIDS patients will need to take itraconazole for life in order to prevent the infection from recurring.
Mild cases of disseminated histoplasmosis may be treated with itraconazole alone. Although this drug generally does not work as quickly as amphotericin B, it causes fewer side effects and can be taken by mouth. Side effects of itraconazole may include headache, dizziness, nausea, vomiting or diarrhea, but these symptoms often go away over time. Use cautiously with a history of liver or kidney problems, or another lung disease. Patients should be monitored closely during treatment.
Pentamidine and Amphotericin B have been used to treat leishmaniasis.
Corticosteroids: Patients with leishmaniasis who develop allergic reactions to the larvae are often prescribed medications called corticosteroids. These medications, including prednisone (such as Deltasone®), help reduce inflammation and allergic symptoms, such as hives or itchy eyes.
Iron supplements: Iron supplements have been used to treat patients with hookworm infections. Iron supplements may help improve a patient's recovery if they are anemic. Patients should talk to their healthcare providers to determine whether or not iron supplementation is necessary.
Pain relievers: Many parasitic infections, including trichinosis and guinea worm disease, may cause severe pain. Commonly used pain relievers include ibuprofen (Motrin® or Advil®) and acetaminophen (Aspirin-Free Anacin®, Tylenol®, or Feverall®).
Hydrocortisone: Hydrocortisone cream has been used to treat chigger bites. The cream is applied to the area to temporarily relieve itching. Hydrocortisone 1% cream, which is available over-the-counter, has anti-inflammatory effects and relieves swelling and redness in addition to itching. Antipruritic (relieves itching) agents, such as calamine lotion (Calamox®) have been applied to the skin to relieve itching
Surgery: Surgery may be necessary to repair intestinal damage or remove worms in patients who have severe ascariasis. The only treatment for guinea worm disease is to surgically remove the worm. Once the worm is removed, the remaining eggs will be excreted in the feces, and the infection is cured.
Other: Since guinea worm disease often occurs in areas of the world where surgery is not widely available, individuals have traditionally used another method to remove the worm. The patient soaks the affected area in water until the worm emerges from the blister. Then a small stick is wrapped around the end of the worm. The worm is pulled out a tiny bit at a time. Sometimes the worm can be pulled out completely within a few days. However, it usually takes several weeks to months for the worm to be completely removed. There are serious health risks associated with this method. If the patient tries to pull too much of the worm out, the worm may break in half. This kills the worm, and releases toxins into the bloodstream. The patient may then suffer from a severe infection. Therefore, this method should only be used as a last resort.
Good scientific evidence
Vitamin A: Vitamin A is a fat-soluble vitamin that is derived from two sources: preformed retinoids and provitamin carotenoids. Retinoids, such as retinal and retinoic acid, are found in animal sources like liver, kidney, eggs, and dairy produce. Carotenoids like beta-carotene (which has the highest vitamin A activity) are found in plants such as dark or yellow vegetables and carrots. Limited research suggests that vitamin A may reduce fever, morbidity, and parasite blood levels in patients with malaria (Plasmodium falciparum infection). However, evidence is currently lacking that vitamin A is equivalent or superior to well-established drug therapies used for the prevention or treatment of malaria. Individuals with malaria or living/traveling in endemic areas should speak with a doctor about appropriate measures.
Vitamin A toxicity, or hypervitaminosis A, is rare in the general population. Vitamin A toxicity can occur with excessive amounts of vitamin A taken over short or long periods of time. Avoid if allergic or hypersensitive to vitamin A. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
Zinc: Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Evidence from human trials suggests that zinc pyrithione shampoo may be an effective treatment for tinea versicolor fungal infections of the scalp. Side effects were not noted. Additional research is needed before a strong recommendation can be made.
Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.
Unclear or conflicting scientific evidence
Berberine: Berberine is a bitter-tasting, yellow, plant alkaloid with a long history of medicinal use in Chinese and Ayurvedic medicine. Berberine has been found to possess antimicrobial properties, and there is limited evidence of anti-inflammatory properties as well. The benefits of berberine in the treatment of leishmaniasis are widely accepted. Berberine is thought to be equally efficacious as the standard drug treatment for cutaneous leishmaniasis, antimonite (sulfide mineral), although limited study of this treatment probably limits its widespread use. Human study has also assessed the use of berberine in combination with pyrimethamine in the treatment of chloroquine-resistant malaria. Well-designed clinical trials are still required.
Avoid if allergic or hypersensitive to berberine, to plants that contain berberine (Hydrastis canadensis (goldenseal), Coptis chinensis (coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric), or to members of the Berberidaceae family. Avoid in newborns due to the potential for an increase in free bilirubin, jaundice, and development of kernicterus. Use cautiously with cardiovascular disease, gastrointestinal disorders, hematologic disorders, leukopenia, kidney disease, liver disease, respiratory disorders, cancer, hypertyraminemia, diabetes, or low blood pressure. Use cautiously in children due to a lack of safety information. Use cautiously in individuals with high exposure to sunlight or artificial light. Use cautiously for longer than eight weeks due to theoretical changes in bacterial gut flora. Use cautiously if taking anticoagulants, antihypertensives, sedatives, anti-inflammatories, medications metabolized by CYP P450 3A4 including cyclosporin, or any prescription medications. Avoid if pregnant or breastfeeding.
Bishop's weed: Limited available human study used 8-methoxypsoralen (8-MOP), a photoreactive plant compound from bishopsweed, for the treatment of tinea versicolor. Clinical studies are needed before a conclusion can be made.
Use cautiously in patients with photosensitivity as bishop's weed may be photoreactive, and cause phototoxic skin damage, phototoxic dermatitis, and pigmentary retinopathy. Use cautiously in patients with bleeding disorders or taking anticoagulants, NSAIDs/anti-platelet agents, or herbs or supplements that increase risk of bleeding because bishop's weed may have additive effects and increase the risk of bleeding. Use cautiously in patients taking drugs or herbs or supplements metabolized by cytochrome P450 as bishop's weed may increase the effects of these agents. Use cautiously in patients with eye disorders, as bishop's weed may cause ocular toxicity. Avoid in patients with known allergy/hypersensitivity to bishop's weed, its constituents, or members of the Apiaceae family.
Bitter orange: Limited available human study found promising results using the oil of bitter orange for treatment of fungal infections. However, due to methodological weakness of this research, further evidence is needed to confirm these results.
Avoid if allergic or hypersensitive to bitter orange or any members of the Rutaceae family. Avoid with heart disease, narrow-angel glaucoma, intestinal colic, or long QT interval syndrome. Avoid if taking anti-adrenergic agents, beta-blockers, QT-interval prolonging drugs, monoamine oxidase inhibitors (MAOIs), stimulants, or honey. Use cautiously with headache, hyperthyroidism (overactive thyroid), or if fair-skinned. Avoid if pregnant or breastfeeding.
Cinnamon: There is currently a lack of available evidence to support the use of cinnamon for AIDS patients with advanced oral candidiasis. More study is needed in this area.
Avoid if allergic or hypersensitive to cinnamon, its constituents, members of the Lauraceae family, or Balsam of Peru. Use cautiously if prone to atopic reactions or if taking cytochrome P450 metabolized agents, anticoagulants (blood thinners), insulin or blood sugar-altering medications, antibiotics, or cardiovascular agents. Avoid if pregnant or breastfeeding.
Corydalis: Corydalis may be helpful in the treatment of infections caused by the parasite Echinococcus granulosus caused by the Hydatid worm. More studies are needed to confirm the antiparasitic effects of corydalis.
Corydalis is generally considered to be safe. Avoid if allergic or sensitive to corydalis. Avoid if taking sedative or hypnotic drugs, drugs that treat abnormal heart rhythms (including bepridil), pain relievers, and anti-cancer drugs. Avoid if pregnant or breastfeeding.
Cranberry: Limited laboratory research has examined the antifungal activity of cranberry. Further research is warranted in this area.
Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Pregnant and breastfeeding women should avoid cranberry in higher amounts than what is typically found in foods.
Garlic: Garlic is used both medicinally and as a food spice. Preliminary research suggests that oral plus intravenous garlic may help manage symptoms of cryptococcal meningitis, a fungal infection that commonly occurs in HIV patients. Further research is needed before recommending for or against the use of garlic in the treatment of this potentially serious condition, for which other treatments are available. Several studies describe the use of garlic as a topical antifungal to treat fungal infections of the skin, including yeast infections. More research is needed in this area.
Use cautiously as garlic can cause severe burns and rash when applied to the skin of sensitive individuals.
Avoid if allergic or hypersensitive to garlic or other members of the Lilaceae(lily) family (e.g. hyacinth, tulip, onion, leek, or chive). Avoid with a history of bleeding problems, asthma, diabetes, low blood pressure, or thyroid disorders. Stop using supplemental garlic two weeks before and immediately after dental/surgical/diagnostic procedures with bleeding risks. Avoid in supplemental doses if pregnant or breastfeeding.
Goldenseal: Goldenseal is one of the five top-selling herbal products in the United States. However, there is little scientific evidence about its safety or effectiveness. A small amount of research reports that berberine, a chemical found in goldenseal, may be beneficial in the treatment of chloroquine-resistant malaria when used in combination with pyrimethamine. Due to the very small amount of berberine found in most goldenseal preparations, it is unclear whether goldenseal contains enough berberine to have these effects. More research is needed before a recommendation can be made.
Avoid if allergic or hypersensitive to goldenseal or any of its constituents, like berberine and hydrastine. Use cautiously with bleeding disorders, diabetes, or low blood sugar. Avoid if pregnant or breastfeeding.
Iodine: Povidone-iodine has been suggested as a topical treatment for molluscum contagiosum. Research is limited in this area.
There have been reports of severe and even fatal reactions to iodine. Avoid iodine-based products if allergic to iodine. Do not use for more than 14 days. Avoid lugol solution and the saturated solution of potassium iodide (SSKI, PIMA) with high amounts of potassium in the blood, fluid in the lungs, bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate or burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is considered to be safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
Oregano: Early study shows that taking oregano by mouth may help treat parasites. Further research is needed to confirm these results.
Research suggests that oregano is well tolerated in recommended doses. Avoid if allergic or hypersensitive to oregano. Use caution if allergic or hypersensitive to other herbs from the Lamiaceae family including hyssop, basil, marjoram, mint, sage and lavender. Use caution with diabetes and bleeding disorders.Pregnant or breastfeeding women should not consume oregano at doses above those normally found in food.
Pomegranate: In clinical study, an extract of pomegranate was shown to be as effective as a commonly used oral gel when used topically to treat candidiasis associated with denture stomatitis (mouth sores). Additional study is needed to confirm pomegranate's antifungal effects.
Avoid if allergic or hypersensitive to pomegranate. Avoid with diarrhea or high or low blood pressure. Avoid taking pomegranate fruit husk with oil or fats to treat parasites. Pomegranate root/stem bark should only be used under the supervision of a qualified healthcare professional. Use cautiously with liver damage or liver disease. Pomegranate supplementation may be unsafe during pregnancy when taken by mouth. The bark, root, and fruit rind may cause menstruation or uterine contractions. Avoid if breastfeeding due to a lack of scientific data.
Probiotics: Combining a probiotic yeast (Saccharomyces boulardii) with antibiotics in the treatment of acute amoebiasis (amoebic dysentery) may decrease the duration of symptoms. Early research suggests that cheese containing probiotics may help reduce the risk of a fungal mouth infection, called thrush, in the elderly. More studies are needed to determine the effectiveness of probiotics for these indications.
Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
Propolis: Propolis is a natural resin created by bees to make their hives. Propolis is made from the buds of conifer and poplar trees and combined with beeswax and other bee secretions. Animal and laboratory studies suggest that propolis may be a beneficial treatment for various types of fungal infections. In humans, a commercial propolis ethanol extract from Brazil, formulated to ensure physical and chemical stability, was found to inhibit fungal infections of the mouth, such as oral candidiasis. Additional research is needed to confirm these findings.
Avoid if allergic or hypersensitive to propolis, black poplar (Populas nigra), poplar bud, bee stings, bee products, honey, or Balsam of Peru. Severe allergic reactions have been reported. There has been one report of kidney failure with the ingestion of propolis that improved upon discontinuing therapy and deteriorated with re-exposure. Avoid if pregnant or breastfeeding because of the high alcohol content in some products.
Riboflavin (vitamin B12): Riboflavin is a water-soluble vitamin. It is needed for normal cell function, growth, and energy production. Small amounts of riboflavin are found in most animal and plant tissues. Low riboflavin levels have been associated with anti-malarial effects. However, it remains unclear exactly how riboflavin supplementation may affect malaria. Additional research is needed in this area.
Avoid if allergic or hypersensitive to riboflavin. Since the amount of riboflavin a human can absorb is limited, riboflavin is generally considered safe. Riboflavin is generally regarded as safe during pregnancy and breastfeeding.
Seaweed, kelp, bladderwrack: Bladderwrack (Fucus vesiculosus) is a brown seaweed found along the northern coasts of the Atlantic and Pacific oceans and North and Baltic seas. Another seaweed that grows alongside bladderwrack is Ascophyllum nodosum, andit is often combined with bladderwrack in kelp preparations. Laboratory research suggests that bladderwrack may have antifungal activity. However, reliable human studies to support this use are currently lacking in the available literature.
Avoid if allergic or hypersensitive to Fucus vesiculosus or iodine. Avoid with a history of thyroid disease, bleeding, acne, kidney disease, blood clots, nerve disorders, high blood pressure, stroke, or diabetes. Avoid if pregnant or breastfeeding.
Selenium: Selenium is a mineral found in soil, water, and some foods. Preliminary research reports that selenium may be beneficial in the prevention of several types of infection. Commercially available 1% selenium sulfide shampoo has been reported as equivalent to sporicidal therapy in the adjunctive treatment of tinea capitis yeast infections. Selenium sulfide shampoo has also been studied as a possible treatment for tinea versicolor. However, research results are inconclusive.
Avoid if allergic or hypersensitive to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
Sweet annie: Sweet annie (Artemisia annua) is also known as Chinese wormwood or sweet wormwood. Although there has been some interest in using sweet annie as an antimalarial therapy, there is currently not enough human evidence to support its use for malaria.
Avoid if allergic or hypersensitive to sweet annie (Artemisia annua), its constituents, or members of the Asteraceae/Compositae family such dandelion, goldenrod, ragweed, sunflower, and daisies. Use cautiously in patients who are pregnant, taking angiogenic agents, or recovering from surgery or other wounds. Use cautiously if taking cardiotoxic or neurotoxic agents or with compromised cardiac or neural function. Use cautiously if taking immunostimulants or quinolines. Avoid if pregnant or breastfeeding.
Tea tree oil: Tea tree oil is purported to have antiseptic properties, and has been used traditionally to prevent and treat infections. Although tea tree oil has been found to have activity against several fungus species in laboratory study, there is currently insufficient human evidence to determine if it is an effective topical treatment for onychomycosis, tinea pedis (athlete's foot), or thrush (oral Candida albicans).
Tea tree oil may be toxic when taken by mouth and therefore, should not be swallowed. Avoid if allergic to tea tree oil or plants of the Myrtle (Myrtaceae) family, Balsam of Peru, or benzoin. Use cautiously with a history of eczema. Avoid if pregnant or breastfeeding.
Thyme: Thyme has been used medicinally for thousands of years. Beyond its common culinary application, it has been recommended for many indications based on proposed antimicrobial, antitussive, spasmolytic, and antioxidant activity. Thyme essential oil and thymol have been shown to have antifungal effects. Topical thymol has been used traditionally to treat paronychia (skin infection around a finger or toenail) and onycholysis (fungal nail infection). Currently, there is insufficient reliable human evidence to recommend for or against the use of thyme or thymol as a treatment for fungal infections.
Avoid if allergic or hypersensitive to thyme, members of the Lamiaceae (mint) family, any component of thyme, or rosemary (Rosmarinus officinalis). Avoid oral ingestion or non-diluted topical application of thyme oil due to potential toxicity. Avoid topical preparations in areas of skin breakdown or injury or in atopic patients due to multiple reports of contact dermatitis. Use cautiously with gastrointestinal irritation or peptic ulcer disease due to anecdotal reports of gastrointestinal irritation. Use cautiously with thyroid disorders due to observed anti-thyrotropic effects in animal research of the related species Thymus serpyllum. Avoid if pregnant or breastfeeding.
Vitamin A: After deworming, children supplemented with vitamin A may be less prone to infection with Acaris parasites. These benefits may be less in children with stunted growth. More research is needed to make a conclusion.
Avoid if allergic to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may have an increased risk of developing lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken in recommended doses. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
Zinc: In a few studies, patients with cutaneous leishmaniasis were injected with zinc sulfate under the skin. Zinc may decrease the severity of infection and re-infection of S. mansoni, but does not seem to prevent initial infection. More research is necessary. The effects of zinc on the rate of parasitic re-infestation has been examined in children. No significant effect of zinc treatment was found. Recent data suggest that supplementation with zinc and vitamin A may favorably alter infection rate and duration among children. Due to conflicting results in this area, more research is needed before zinc can be recommended for the treatment of parasites.
Results are contradictory regarding the effect of zinc on malaria symptoms. Some randomized, double-blind clinical trials suggest no effect of zinc supplementation on the severity of malaria. Other studies suggest that zinc supplementation may reduce the number of stays in the hospital and death rate due to P. falciparum infection. Further well-designed, randomized and controlled trials are required to address these discrepancies.
Zinc (zinc sulfate, zinc acetate, zinc glycine, zinc oxide, zinc chelate, and zinc gluconate) is generally considered safe when taken in the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.
Wear gloves when gardening or handling soil. Wash hands thoroughly with soap and water after coming into contact with soil.
Wash hands with soap and water after changing a diaper.
Wash hands thoroughly before handling food.
Do not eat raw or undercooked meat. Individuals should be especially careful when preparing pork, venison, or lamb because they contain the most dangerous parasites.
Freezing meat or fish for at least 12 hours has been shown to kill tapeworm eggs.
Wash kitchen utensils thoroughly with soap and water.
Thoroughly wash all fruits and vegetables.
Avoid raw produce when visiting parts of the world with poor sanitation.
Individuals who are in areas of the world with poor sanitation should only drink bottled water. If this is not possible, individuals should boil their water before drinking it. This kills any parasites that may be living in the water.
Individuals who work in areas that are known to be infested with a parasitic fungus called Histoplasma capsulatum (e.g. caves or birds coops) should wear a face mask. This prevents the spores from entering the individual's mouth or nose.
Since many insects, including mosquitoes, deerflies, and sandflies, are known to carry parasitic diseases, individuals should consider wearing insect repellent when outdoors. Also, since mosquitoes are most active at dawn and dusk, individuals should limit the time spent outdoors during these peak times. In addition, individuals should get rid of items around the home that collect water (such as buckets and empty flower pots) because mosquitoes lay their eggs on the surface of water.
Patients who are visiting tropical areas of the world where malaria is common should sleep with a bednet to prevent mosquitoes and other bugs from transmitting diseases during the night.
Individuals who plan to travel to areas where parasitic infections are common (such as Africa, Asia, the Middle East, South America, and Central America), should talk to their healthcare providers to learn how to reduce their risks of acquiring infections.