Pediatric deworming, do you know this?
Author 丨 Small good
Source 丨 Pediatrics Channel of the Medical Community
What are the manifestations of parasite infection?
1. Skin spots: white nearly round or oval patches appear on the face and neck;
2. Sleep at night is easy to wake up, can be accompanied by grinding teeth and drooling and other phenomena;
3. Pain around the navel, itching of the anus, etc.;
4. Without obvious reasons, the child's skin repeatedly appears "wind knots";
5. Partial food performance: eat some strange food.
Why is autumn the right season for deworming?
Children over 2 years of age are more susceptible to parasite infection due to the diversification of food and changes in the dining environment, and the increased chance of contact with insect eggs. In the summer, there are more opportunities to eat raw and cold vegetables, melons and fruits and raw water, so there is more chance of infection with insect eggs, and it takes about 60 to 70 days for eggs to develop into adult worms. Autumn deworming can annihilate adults and eggs in one fell swoop and is the ideal season. Timely use of deworming drugs can improve children's health, nutrition and development.
Characteristics of albendazole
Albendazole (commonly used as enteroleptics) is currently the most widely used anthelmintic drug, with cross-class, broad-spectrum, efficient and low-toxicity characteristics. It is an anthelmintic drug recommended by the World Health Organization (WHO), which is an OTC Class A drug, and patients can purchase and use it themselves.
According to a retrospective review of Parasitology in 2000, the cure rate and egg killing rate of albendazole for common intestinal helminthiasis are shown in the table below:
Cure rate and egg killing rate of albendazole for common intestinal helminthiasis
Parasitic species
Cure rate
Egg killing rate
roundworm
94.6%
98．6%
pinworm
97.8%
N/A
hookworm
77.7%
87.8%
Duodenal hookworm
91.8%
—
American hookworm
75.%
whipworm
47.7%
75.4%
Tiny membranous tapeworm
68.5%
Tapeworm genus
84.7%
Mechanism of action
Albendazole is converted in the body by the liver into propylthiazole-sulfoxide and propythionazole-sulfone, the former of which is an insecticidal component. The distribution in the body is in order of liver, kidney, muscle, can pass through the blood-brain barrier, and there is also a certain concentration in brain tissue. Its mechanism of action is to inhibit the absorption of glucose by parasites, resulting in loss of energy in the insect body, while inhibiting the fulvic acid reductase system, hindering the production of ATP, resulting in the inability of parasites to survive and develop, and playing an effect of killing adults, larvae and eggs.
Comparison with traditional anthelmintics
The pharmacological effect of traditional anthelmintic drugs such as piperazine phosphate (pagoda sugar) is to paralyze the worm body, so that it cannot be attached to the intestinal wall of the host, and excreted with the help of intestinal peristalsis, which is only good for adult worms, and the antibacterial spectrum is narrow, which is suitable for the col cramping period of intestinal ascariasis and biliary ascariasis, and also has a certain effect on pinworm disease.
Dosage
1. Commonly used amount: 2 tablets (400 mg) for children over 2 years old and adults, 1 tablet (200 mg) for children over 2 years old with simple pinworm and simple mild roundworm infection. Take only once (once is a course of treatment). Tablets should be taken with water. Some people, especially children, may have difficulty swallowing the tablets intact and can crush or chew the tablets and take them with a small amount of water.
2. For other parasitic infections or complex mixed infections, including cysticercosis, taeniasis, echinococcosis, trebuscid disease, liver fluke disease, trichinellosis, etc., the dosage and course of treatment vary greatly and need to be used under the guidance of a professional doctor.
Do I need to take it on an empty stomach?
Since albendazole is insoluble in water and is slowly absorbed in the intestine, fat-soluble components in food aid in absorption. Therefore, this product can be swallowed, chewed or crushed and swallowed with food, and does not need to be fasting or enema before taking the drug.
What are the adverse reactions?
Albendazole and its metabolites are excreted from the urine and 13% from the feces within 24 hours, with no accumulation toxicity in the body. The incidence of adverse reactions to albendazole is low (about 1%). A small number of patients are accompanied by gastrointestinal discomfort, headache, etc., which can generally disappear within 48 hours. In addition, when treating roundworm disease, the phenomenon of spitting roundworms is occasionally seen.
contraindication
Children under 2 years of age are contraindicated due to immature liver and kidney function, and the safety rating of albendazole for pregnancy is grade C, and it is also contraindicated for pregnant women, lactating women, acute disease, kidney disease, purulent or diffuse dermatitis, epilepsy or allergies to other drugs.
Precautions
1. Pinworm disease is prone to repeated infection, so the treatment should be repeated once after 2 weeks of treatment;
2. This product should be placed in a cool and dark place, sealed and stored;
3. Children should be under the supervision of an adult;
4. In case of overdose, consult a doctor immediately.
Insect control is key
1. Sandy soil There may be parasitic eggs in the sandy soil, especially those in the forest or in the suburbs, after playing, be sure to tell the child to wash his hands carefully;
2. Drinking raw water or water that is not completely boiled may bring parasite eggs into the human body, and should be avoided;
3. Fresh fruits and vegetables and uncooked fish are prone to parasitic eggs on fresh fruits and vegetables and undercooked fish, which will increase the chance of parasitic infection;
4. Hygiene habits, including children over 1 year old, such as allowing fingers and wearing open crotch pants, should be corrected; wash their hands frequently before meals and after going to the toilet; eat less raw and cold food.
【Reference】
1. National Pharmacopoeia Commission. Pharmacopoeia of the People's Republic of China Clinical Drug Instructions: 2010 Edition[J]. 2011.
2.J. , HORTON. Albendazole: a review of anthelmintic efficacy and safety in humans[J]. Parasitology, 2000, 121(s1):S113.
3.WHO (1998). Guidelines for the Evaluation of Soil-Transmitted Helminthiasis and Schistosomiasis at Community Level. WHO/CDS/SIP/98.1