acute

Strongyloidiasis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Egyptian National Drug Formulary - antimicrobial-2023.pdf, Ivermectin monograph (chapter PDF p31) · MSF Essential Drugs 2024 (albendazole oral monograph, indication "Trichuriasis (Trichuris trichiura), strongyloidiasis (Strongyloides stercoralis)") · Strongyloidiasis - disease-level clinical article (strongyloidiasis-full.txt)

Verified against4 documents

Egyptian National Drug Formulary - antimicrobial-2023.pdf, Ivermectin monograph (chapter PDF p31)
Strongyloidiasis - disease-level clinical article (strongyloidiasis-clinical.txt)
MSF Essential Drugs 2024 (albendazole oral monograph, indication "Trichuriasis (Trichuris trichiura), strongyloidiasis (Strongyloides stercoralis)")
Strongyloidiasis - disease-level clinical article (strongyloidiasis-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (8)

Most infections cause no symptoms at all, especially in people with normal immunity
Unexplained eosinophilia can be the only clue when the infection is silent
An intensely itchy, snake-like rash can mark where the larvae entered the skin [itching · rash]
This itching, called ground itch, is usually on the feet or hands but can turn up almost anywhere and can last up to 3 weeks [itching]
Larvae migrating through the lungs can cause cough, breathlessness, and wheeze resembling a Loffler-like syndrome [breathlessness · cough · wheeze]
Gut involvement brings abdominal pain, diarrhea, vomiting, and epigastric discomfort [abdominal pain · diarrhoea · epigastric pain · vomiting]
Chronic low-level infection can persist for years with mild, intermittent cough, wheeze, breathlessness, belly pain, poor appetite, diarrhea, or constipation [abdominal pain · breathlessness · constipation · cough · diarrhoea · poor appetite · wheeze]
In hyperinfection, patients commonly develop fever, sepsis, and unexplained gram-negative or mixed bacteremia from gut bacteria crossing into the blood [fever · sepsis]

Signs — what you find (6)

Rapid migration of larvae under the skin produces larva currens - raised, red, snake-like tracks that can advance 5 to 15 cm per hour
Recurrent hives can be seen on the skin in chronic infection [urticaria]
In hyperinfection, larvae can spread beyond the lungs and gut to the liver, pancreas, kidneys, mesenteric nodes, brain, and skeletal muscle
Severe pulmonary hyperinfection can show coughing blood, diffuse infiltrates, and respiratory failure [cough]
A characteristic purple rash around the navel can appear when larvae disseminate beyond the usual pulmonary-intestinal route [rash]
Eosinophilia is often missing in hyperinfection despite how severe the disease is, usually because of prior steroid treatment

Tests (7)

No single test is accepted as the gold standard, since larval shedding is often low and inconsistent
A single stool exam only catches the parasite about 21 percent of the time
PCR-based molecular testing is highly sensitive and nearly 100 percent specific but only available at specialized labs
Serology such as indirect fluorescent antibody testing, ELISA, or an NIE-antigen assay is the most sensitive option and useful for excluding infection given its strong negative predictive value
A negative serology result does not fully rule out infection
Positive serology needs cautious interpretation, since cross-reaction with other worm infections, particularly filaria, can limit its specificity
In hyperinfection, larvae are often found more reliably in respiratory samples like sputum, bronchoalveolar lavage, or lung biopsy

If not this — what else fits (2)

Chronic belly pain and diarrhea overlap with giardiasis, amebiasis, IBD, IBS, celiac disease, SIBO, appendicitis, obstruction, proctitis, or peritonitis
Itchy, snake-like rashes overlap with cutaneous larva migrans, scabies, allergic contact dermatitis, or urticaria from other causes

SourceStatPearls "Strongyloidiasis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Anthelmintic - second-line alternative to ivermectin

MAIN TREATMENT - choose one

IVERMECTIN

1st line

Formoral.solid

Adult dose and duration

200 mcg/kg/day x 1 to 2 days

Paediatric dose

Same weight-based dose (200 mcg/kg/day for 1-2 days) applies from adolescents down to children weighing 15 kg or more; not established below 15 kg in this excerpt.

Dose source

Egyptian National Drug Formulary - antimicrobial-2023.pdf, Ivermectin monograph (chapter PDF p31)

Why

Formulary explicitly names intestinal strongyloidiasis with a specific weight-based dose - the guideline-backed first choice.

Cautions

Take on an empty stomach with water for best absorption.
Screen for and treat before starting any steroid or immunosuppressive therapy - unrecognised strongyloidiasis can progress to life-threatening hyperinfection syndrome once the patient is immunosuppressed.
Avoid in pregnancy unless the benefit clearly outweighs the risk.
Investigate unexplained eosinophilia and signs of hyperinfection in an immunocompromised patient as potentially urgent.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
IVACTIN 6MG 6 F.C.TABS.	DELTA PHARMA	13.50 EGP (2.25/unit)
IVERZINE 6MG 24 TABS.	UNIPHARMA CO. > UNIPHARMA	84.00 EGP (3.50/unit)

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Strongyloidiasis - disease-level clinical article (strongyloidiasis-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - Hyperinfection/disseminated strongyloidiasis is a distinct, very-high-mortality presentation needing a different treatment pathway; immunosuppressed patients, and those about to start immunosuppression, are at particular risk.

ANTHELMINTIC - SECOND-LINE ALTERNATIVE TO IVERMECTIN

ALBENDAZOLE

Anthelmintic - second-line alternative to ivermectin

2nd line

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg once daily x 3 days

Paediatric dose

(MSF states age and weight bands rather than mg/kg for this indication: child over 6 months, 400 mg once daily for 3 days; child over 6 months but under 10 kg, 200 mg once daily for 3 days. Not to be given under 6 months.)

Dose by age
Over 6 months:	400 mg once daily for 3 days; under 10 kg, 200 mg once daily for 3 days. Not to be given under 6 months.

Dose source

MSF Essential Drugs 2024 (albendazole oral monograph, indication "Trichuriasis (Trichuris trichiura), strongyloidiasis (Strongyloides stercoralis)")

Why

The card carried ivermectin alone. The disease article names albendazole as the second-line agent, and MSF names strongyloidiasis in albendazole's own indications with a dose attached to that indication. The dose here is MSF's (400 mg once daily for 3 days), NOT the article's 400 mg twice daily for 3-7 days - the dosing document decides the dose. MSF's own remark that ivermectin is more effective is on the row, so the second-line status is visible rather than implied by the ordering.

Cautions

Do not administer to children under 6 months.
In the treatment of strongyloidiasis, ivermectin is more effective than albendazole.
May cause: gastrointestinal disturbances, headache, dizziness;
Tablets are to be chewed or crushed: follow manufacturer's recommendations.
In pregnancy, avoid albendazole during the first trimester.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
ALBENDAZOLE 400 MG 6 TABS	PHARMA CURE PHARMACEUTICALS > PHARMA CURE	46.00 EGP (7.67/unit)
ANTIZOLE 100MG/5ML SUSP. 30ML? strength differs? different route - not oral solid	ALEXANDRIA	19.00 EGP
ALZENTAL 20MG/ML SUSP. 20ML? strength differs? different route - not oral solid	EIPICO	21.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.