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 or pyrantel (Antiminth®) may be taken as alternative. 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 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 (Quinamm® or Quiphile®), 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 antifungal medication called amphotericin B (Amphocin® or Fungizone intravenous). 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, which is derived from two sources: retinoids and carotenoids. Retinoids are found in animal sources, such as livers, kidneys, eggs, and dairy products. Carotenoids are found in plants, such as dark or yellow vegetables and carrots. Limited research suggests that vitamin A may reduce fever, morbidity, and the number of parasites in the blood (Plasmodium falciparum infection). However, there is no evidence that vitamin A is equivalent or superior to well-established drug therapies used for prevention or treatment of malaria. Patients with malaria or living/traveling in endemic areas should speak with their physicians about appropriate measures.
Avoid if allergic or hypersensitive 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 at recommended doses. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
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 is present in the roots, rhizomes, and stem bark of various plants, including goldenseal, goldenthread, Oregon grape, barberry, and tree turmeric. One trial has assessed the use of berberine in combination with pyrimethamine in the treatment of chloroquine-resistant malaria. Well-designed clinical trials are still required in this field.
The benefits of berberine in the treatment of leishmaniasis are widely accepted. Berberine is thought to be as effective as the standard drug treatment of cutaneous leishmaniasis, antimonite (sulfide mineral). However, limited study of this treatment probably limits its widespread use. Additional study is needed to confirm these results.
Avoid if allergic or hypersensitive to berberine, plants that contain berberine, or any members of the Berberidaceae family. Avoid in newborns due to the potential for an increase in free bilirubin, jaundice, and the development of kernicterus. Use cautiously with heart 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 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, or drugs that are broken down by the liver. Avoid if pregnant or breastfeeding.
Bitter orange: Bitter orange (Citrus aurantium) comes from a flowering, fruit-bearing evergreen tree native to tropical Asia. It is now widely grown in the Mediterranean region and elsewhere. Preliminary research shows promising results using oil of bitter orange as an antifungal agent. However, further evidence is needed to determine whether or not it can help prevent parasitic fungal infection in humans.
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.
Cranberry: Cranberries come from small evergreen shrubs with tart, red, edible berries. The berries are used in sauces, jellies, and drinks.
Limited laboratory research has examined the antifungal activity of cranberry. There are no reliable human studies supporting the use of cranberry in this area. Further research is needed to determine whether or not cranberry may help prevent parasitic fungal infections in humans.
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. Avoid more than the amount usually found in foods 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, such as berberine or hydrastine. Use cautiously with bleeding disorders, diabetes, or low blood sugar. Avoid if pregnant or breastfeeding.
Oregano: Oregano is a perennial herb. The leaves, stems, and flowers are used medicinally. It is commonly used as a food flavoring and preservative. 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 cautiously if allergic or hypersensitive to other herbs from the Lamiaceae family including hyssop, basil marjoram, mint, sage, or lavender. Use cautiously with diabetes or bleeding disorders.Pregnant or breastfeeding women should not consume oregano at doses more than those normally found in food.
Probiotics: Probiotics are beneficial bacteria and are sometimes called friendly germs. They help maintain a healthy intestine, aid in digestion, and help keep harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Research suggests that combining probiotic yeast (Saccharomyces boulardii) with antibiotics may reduce the duration of acute amebiasis. More studies are needed to determine recommendations for probiotics in acute amebiasis.
Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
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, and anti-riboflavin therapies were proposed in the 1980s, although more recent evidence has challenged this proposed association.
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 being safe during pregnancy and breastfeeding if consumed in doses that do not exceed the recommended dietary allowance (RDA).
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, anditis often combined with bladderwrack in kelp preparations. Laboratory study suggests antifungal and antibacterial activity of bladderwrack. However, further research is needed to determine whether or not this treatment effectively prevents parasitic fungal infections in humans.
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.
Sweet annie: Sweet annie (Artemisia annua) is also known as Chinese wormwood or sweet wormwood. Artemisia annua can be grown locally and contains the antimalarial compound artemisinin. Artemisia annua preparations may have some antimalarial properties. Although there has been some interest in using Artemisia annua as an antimalarial, little clinical evidence is currently available. Of the poor-quality studies that have been conducted, one showed a disappearance of parasitemia, while the other showed a lower rate of parasitemia with a high rate of replication (called recrudescence rate). More high-quality research should be conducted to evaluate whether or not Artemisia annua is a beneficial treatment 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, or 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, immunostimulants, or quinolines. Use cautiously with compromised heart or brain function. Avoid if pregnant or breastfeeding.
Zinc: Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Results are contradictory for 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.
In a few studies of varying quality, patients with cutaneous leishmaniasis were injected with zinc sulfate intralesionally. One study found zinc sulfate was better than meglumine antimoniate for the first four weeks, but no statistical differences were observed after six weeks. Zinc may decrease the severity of infection and re-infection of S. mansoni, but does not seem to prevent initial infection. More research should be done in this area to examine how zinc affects the S. mansoni life cycle and whether this data can be extrapolated to other species of Schistosoma. The effects of zinc on the rate of parasitic re-infestation have been examined in children. No significant effect of zinc treatment was found. Due to conflicting results in this area, more research is needed before zinc can be recommended for the treatment of parasites.
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.
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.