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PARENTERAL ADMINISTRATION OF IVERMECTIN IN A PATIENT WITH DISSEMINATED STRONGYLOIDIASIS

We report the case of a 23-year-old Caribbean man with disseminated strongyloidiasis (co-infected with human T cell lymphotropic virus I/II)), severe hypoalbuminemia, and a paralytic ileus. Subcutaneous ivermectin (200 µg/kg) was administered daily for 14 days because of the inability to effectively administer oral albendazole and oral ivermectin. Three hours after the third daily dose of oral ivermectin, the serum ivermectin concentration was only 0.8 ng/mL, but it increased several fold to 5.8 ng/mL 16 hours after the first dose of subcutaneous ivermectin. During the course of subcutaneous treatment, ivermectin clearance was higher than expected (46.0 L/hour, normal = 31.8 L/hour). This is likely the result of severe hypoalbuminemia since ivermectin is highly protein bound. The ability to achieve adequate levels of ivermectin after oral administration in patients with disseminated strongyloidiasis may be impaired, highlighting the need for alternative routes of administration of ivermectin in these patients.

Received April 1, 2005. Accepted for publication June 14, 2005.

^* Address correspondence to Christina Greenaway, Department of Microbiology, Division of Infectious Diseases, Room G-143, Sir Mortimer B. Davis-Jewish General Hospital, 3755 Côte St., Catherine Road, Montreal, Quebec, Canada, H3T 1E2. E-mail: ca.greenaway{at}mcgill.ca

Authors’ addresses: Stephen A. Turner and Christina Greenaway, Department of Microbiology, Division of Infectious Diseases, Room G-143, Sir Mortimer B. Davis-Jewish General Hospital, 3755 Côte St., Catherine Road, Montreal, Quebec, Canada, H3T 1E2, E-mails: trnrstephen{at}aol.com and ca.greenaway{at}mcgill.ca. J. Dick MacLean, McGill University for Tropical Diseases, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada, H3G 1A4, E-mail: dick.maclean{at}mcgill.ca. Lawrence Fleckenstein, University of Iowa College of Pharmacy, S-427-Phar, 115 South Grand Ave, Iowa City, IA 52242, E-mail: l-fleckenstein{at}uiowa.edu.

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