Failure of ivermectin per rectum to achieve clinically meaningful serum levels in two cases of Strongyloides hyperinfection.
Two cases of Strongyloides hyperinfection are presented. Ivermectin was initially administered orally and per rectum pending the availability of subcutaneous (SC) preparations. In neither case did rectal suppositories of ivermectin achieve clinically meaningful serum values. Clinicians should use SC preparations of ivermectin as early as possible in Strongyloides hyperinfection and dissemination.
Division of General Internal Medicine, University Health Network, Toronto, Canada; Division of Infectious Diseases, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada; Department of Pharmacy, St. Michael's Hospital, Toronto, Canada; Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, Iowa isaac.bogoch@uhn.ca.
Isaac I
II
Bogoch
Division of General Internal Medicine, University Health Network, Toronto, Canada; Division of Infectious Diseases, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada; Department of Pharmacy, St. Michael's Hospital, Toronto, Canada; Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, Iowa.
Kamran
K
Khan
Division of General Internal Medicine, University Health Network, Toronto, Canada; Division of Infectious Diseases, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada; Department of Pharmacy, St. Michael's Hospital, Toronto, Canada; Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, Iowa.
Howard
H
Abrams
Division of General Internal Medicine, University Health Network, Toronto, Canada; Division of Infectious Diseases, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada; Department of Pharmacy, St. Michael's Hospital, Toronto, Canada; Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, Iowa.
Caroline
C
Nott
Division of General Internal Medicine, University Health Network, Toronto, Canada; Division of Infectious Diseases, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada; Department of Pharmacy, St. Michael's Hospital, Toronto, Canada; Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, Iowa.
Elizabeth
E
Leung
Division of General Internal Medicine, University Health Network, Toronto, Canada; Division of Infectious Diseases, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada; Department of Pharmacy, St. Michael's Hospital, Toronto, Canada; Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, Iowa.
Lawrence
L
Fleckenstein
Division of General Internal Medicine, University Health Network, Toronto, Canada; Division of Infectious Diseases, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada; Department of Pharmacy, St. Michael's Hospital, Toronto, Canada; Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, Iowa.
Jay S
JS
Keystone
D000285:Administration, Rectal; D000328:Adult; D000818:Animals; D000977:Antiparasitic Agents / Q000008:administration & dosage* / Q000097:blood; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D007418:Intestinal Pseudo-Obstruction / Q000150:complications*; D007559:Ivermectin / Q000008:administration & dosage* / Q000097:blood; D008297:Male; D008875:Middle Aged; D017171:Strongyloides stercoralis; D013322:Strongyloidiasis / Q000150:complications / Q000188:drug therapy*; D017211:Treatment Failure
D000977:Antiparasitic Agents; D007559:Ivermectin