title: Subcutaneous ivermectin use in the treatment of severe Strongyloides stercoralis infection: two case reports and a discussion of the literature.
abstract: BACKGROUND
  Strongyloides stercoralis infection presents with varying degrees of severity, but it often primarily involves the small bowel. In severe infection and cases of hyperinfection, ileus and small-bowel obstruction may prevent enteral absorption of anthelminthics such as ivermectin. At present there are no parenteral anthelminthics licensed for use in humans.
  
  
  METHODS
  Here, we describe two cases of severe S. stercoralis infection treated with an unlicensed veterinary preparation of subcutaneous ivermectin, and we discuss the published reports of the use of this treatment elsewhere.
  
  
  RESULTS
  Both patients were successfully treated with subcutaneous ivermectin, and both recovered completely.
  
  
  CONCLUSIONS
  Despite the limited published experience of parenteral ivermectin use, there is evidence that it may be a safe and effective treatment for severe strongyloidiasis. However, more data are needed to guide dosing schedules and monitoring for toxicity.
authors.affiliation: Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK jessica.barrett@gstt.nhs.uk.
authors.forename: Jessica
authors.initials: J
authors.lastname: Barrett
authors.affiliation: Department of Infectious Diseases, University College Hospital, 235 Euston Road, London NW1 2BU, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Broderick
authors.affiliation: Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Soulsby
authors.affiliation: Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Wade
authors.affiliation: Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: William
authors.initials: W
authors.lastname: Newsholme
mesh_terms: D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D007559:Ivermectin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D017171:Strongyloides stercoralis / Q000187:drug effects*; D013322:Strongyloidiasis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000871:Anthelmintics; D007559:Ivermectin