Are there any data on ivermectin (Stromectol) treatment of children less than 5 years? Can the tabl

Fråga: Are there any data on ivermectin (Stromectol) treatment of children less than 5 years? Can the tablets be crushed?

A 1.5-year-old girl needs treatment for cutaneous larva migrans (CLM). According to available literature ivermectin should not be used in children less than 5 years.

Sammanfattning: Ivermectin has not yet been approved for children less than 5 years since safety has not been established. In the literature we found one report where ivermectin had been given to two infants. Good efficacy and no significant adverse effects were noted. Stromectol tablets can be crushed.

Svar: Ivermectin is effective and highly potent against at least some developmental stages of many parasitic nematodes and insects that affect animals and humans (1). Ivermectin is well tolerated by uninfected humans and other mammals. In humans, ivermectin toxicity nearly always results from Mazzoti-like reactions (itching, skin rashes, lymph node enlargement etc) to dying microfilariae; the intensity and nature of these reactions relate to the microfilarial burden and the duration and type of filarial infection (1).

Because of its effects on GABA receptors in the CNS, ivermectin is contraindicated in conditions associated with an impaired blood-brain barrier (1).

Ivermectin has not yet been approved for use in children less than 5 years since the safety has not been established (2). In a study of the efficacy and tolerability of ivemerctin in patients with CLM, 2 of the 64 enrolled patients were less than 2 years (aged 17 and 20 months) (3). Ivermectin, 200 ug/kg, was given to the 2 children; good efficacy and tolerability were noted, although one child received a second dose on day 8 because of lack of improvement. To our knowledge, this is the first time that the use of ivermectin in young children has been reported.

Stromectol (ivermectin) tablets can be crushed (4). 1 Hardman JG, Limibrd LE, Goodman Gilman A, editors. Goodman & Gilman´s The pharmacological basis of therapeutics. 10th ed. New York: McGraw-Hill; 2001 2 Rodriguez-Perez MA, Danis-Lozano R, Rodriguez MH, Bradley JE. Comparison of serological and parasitological assessments of Onchocerca volvulus transmission after 7 years of mass ivermectin treatment in Mexico. Trop Med Int Health 1999;4(2):98-104. 3 Bouchaud O, Houze S, Schiemann R, Durand R, Ralaimazava P, Ruggeri C, Coulaud JP. Cutaneous Larva Migrans in Ttravelers: A Prospective study, with Assessment of Therapy with Ivermectin. Clin Infect Dis 2000;31:493-8. 4 Barbro Hermansson, Hospital Pharmacy at Huddinge University Hospital, personal communication