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PubMed1999

Use of ivermectin for the management of scabies in a nursing home.

Ivermectin was used for the treatment of a scabies outbreak in a nursing home. Among the 128 residents, 42 presented pruritus or cutaneous lesions and scabies was parasitologically demonstrated in seven patients. All residents were treated with two 12 mg doses of ivermectin given two weeks apart. Ivermectin treatment associated with procedures for environmental disinfection led to the control of the outbreak. In only one case, was there a failure of the treatment. It is concluded that oral ivermectin is an effective and practical therapy for scabies in nursing homes.

Administration, Oral↗
PubMed2001

Circulating filarial antigens for monitoring the efficacy of ivermectin in treatment of filariasis.

Seventy-three asymptomatic bancroftian filariasis patients with positive microfilaria in their blood films were included. The patients were randomly divided into 2 groups: ivermectin group (50 cases) given 2 doses each of 100 ug/kg body weight, 3 months apart, and 23 cases had 2 doses of placebo. The study was run blindly for one year. The initial mean microfilaria (MF) count was 111/ml. At 3 months after ivermectin therapy, mean MF became 7.8/ml and 24% of ivermectin treated cases had no detectable MF (P <0.05). At 6, 9 and 12 months, the mean MF count became 4.1, 6.5 and 11/ml with amicrofilaria in 54%, 42% and 40% of treated cases respectively (P <0.05). On the other hand, no statistically significant change in the mean MF count in placebo group was detected. The routine laboratory investigations were unchanged or slightly improved at 3 and 6 months. Side effects after the first dose of ivermectin were mild fever in 16% and weakness in 20%. None was recorded after the second dose. Circulating filarial antigens could be detected in 66% of cases before treatment, as all cases with high microfilaremia had positive antigenemia. The mean antigen level started to decline significantly after 9 months post treatment. At the end of the study (one-year), all negative microfilaremic cases had negative antigen levels, indicating that detection of antigen in-patients sera is a very good indicator of cure and efficacy of the drug.

Adolescent↗
PubMed2001

Increased pathology incidence in the forestomach of rats maintained on a diet containing ivermectin and given a single dose of N-methyl-N1-nitro-N-nitrosoguanidine.

Ivermectin is widely used against parasitic infections in veterinary and human medicine and was found to promote the growth of lesions leading to neoplasia when given continuously in the diet to Wistar rats receiving a single low dose of N-methyl-N1-nitro-N-nitrosoguanidine (MNNG). No tumors or pathological lesions were observed in the forestomach of the control animals or those given ivermectin alone. However, compared to animals receiving MNNG alone, rats maintained on a diet containing ivermectin (2 ppm) and given MNNG (12.5 mg/kg) by gavage showed an increased number of neoplasms (9/26 vs 3/18; p = 0.30) and a statistically significant fourfold increase in the number of pathological lesions (18/26 vs 3/18; p = 0.002), which include preneoplasia in the forestomach. In all cases, the pathological lesions were more severe in the animals receiving ivermectin and MNNG, compared to those receiving MNNG alone.

Administration, Oral↗
PubMed2003

Case report: Rectal adminstration of ivermectin to a patient with Strongyloides hyperinfection syndrome.

Strongyloides hyperinfection syndrome may be complicated by paralytic ileus that interferes with the absorption of oral anti-helminthics. We report on the administration of ivermectin as a rectal enema preparation to a renal transplant recipient with Strongyloides hyperinfection syndrome and progressive ileus. Attempts at treatment using nasogastric albendazole and ivermectin were unsuccessful despite clamping the nasogastric tube after drug administration. Ivermectin tablets were ground to a powder, resuspended in a commercially available suspending agent, and administered per rectum. The suspending agent was chosen for its near-physiologic osmolality to allow longer retention, in contrast to many enema preparations that have a laxative effect. The patient improved markedly within 72 hours of initiation of the therapy per rectum and recovered fully. Ivermectin administered as an enema may be beneficial in patients with severe strongyloidiasis who are unable to absorb or tolerate oral therapy.

Administration, Rectal↗
PubMedDate not supplied

[A trial at using the systemic action of ivermectin for suppressing the vector capacity of ticks (Ixodidae) infected with the tick-borne encephalitis virus].

Adult Dermacentor marginatus hatched from nymphs infected with TBE virus and poisoned with ivermectin retain their vector abilities. Even small individuals with a 1.5-2 times lesser mass as against the reference mass contain the virus in the body in the same titers and the virions in salivary gland alveoli. Administration of an oil solution of ivermectin into the stomach of white mice, nymph feeders, in a dose surpassing threefold the dose recommended for intramuscular injection of this agent completely suppressed shedding of intact nymphs but did not suppress it in those infected. The nymph mass, size and mass of adult ticks hatched from them dropped under the effect of ivermectin dosage build-up in both intact and infected ticks, but these processes were slower in ticks infected with TBE virus. The authors suggest that the ticks infected with TBE virus are much more resistant to the process of gamma-aminobutyric acid depression, the mechanism of ivermectin action. They emphasize the necessity of bearing in mind the possible differences in the reactions to systemic poisons of intact and infected ticks when organizing vector control measures.

Animals↗
PubMed1992

[Efficacy of ivermectin for control of microfilaremia recurring after treatment with diethylcarbamazine. I. Clinical and parasitological observations].

We compared the efficacy of a single dose of ivermectin with that of a standard course of deithylcarbamazine (DEC) for the control of microfilaremia in 60 patients with banrroftian filariasis who had developed recurrent microfilaremia after each of three or more prior treatments with DEC. The study was done as a randomized, double-blind trial. Complete, but transient clearance of microfilaremia was observed in both treatment groups. One year later, recurrent microfilaremia was present in 7 patients treated with ivermectin and in 5 treated with DEC. Pretreatment levels of microfilaremia were significantly higher in patients who relapsed within one year after treatment than in those who remained amicrofilaremia. Side effects of either treatment were common but mild. Febrile reactions were more frequent in the ivermectin group: while localized reactions consistent with a flare up of acute filarial disease occurred mostly in the DEC group. We conclude that ivermectin is an effective and practical alternative to DEC for treatment of recurrent microfilaremia due to bancroftian filariasis.

Adolescent↗
PubMed2003

[Ivermectin inhibits activation of Kupffer cells induced by lipopolysaccharide toxin].

Lipopolysaccharide-stimulated liver macrophages (Kupffer cells) secrete many physiologically active substances responsible for inflammatory reaction of the organism. The mechanism by which ivermectin, a macrocyclic lactone possessing a broad antiparasitic activity, modulates basic effects elicited by lipopolysaccharide in the primary culture of rat Kupffer cells was studied. It was found that ivermectin in the absence of endotoxin did not affect a functional state of the Kupffer cells. Preincubation of Kupffer cells with ivermectin (1 mM), however, significantly blocked response to the subsequent administration of lipopolysaccharide (1 mg/ml). In particular, secretion of tumor necrosis factor TNF alpha, nitric oxide NO and prostaglandin E2 was suppressed. Also, an LPS-triggered rise in the intracellular concentration of calcium ions was less pronounced. Removal of chloride anions from the extracellular medium completely abolished inhibitory effects of ivermectin. It is suggested that invermectin exerts its action via binding to the glycine-gated chloride receptors/channels of the Kupffer cells, which may reduce toxic reactions manifestations observed under infections caused by Gram-negative bacteria.

Animals↗
PubMed2004

Use of neostigmine in massive ivermectin toxicity in cats.

Over-the-counter availability of drugs in developing countries poses the risk of their abuse and overdosing in animals by the owners. This report describes ivermectin toxicosis and its treatment with neostigmine methylsulfate in 2 kittens and an adult cat that had been massively overdosed by their owners. Of two 4-w-old 300 g kittens, one was injected with 1.5 ml ivermectin (15 mg; corresponding to 250 times the recommended dose) by the owner and became comatose, started salivation and died after 2 1/2 h. The other kitten was treated with about 0.75 ml ivermectin (7.5 mg; corresponding to 125 times the recommended dose) by the same owner and developed ataxia and salivation after 2 h, went into coma the next morning and was presented for treatment with mydriasis, coma, slight fever (102.4 F), tachypnea (48/min) and severe tachycardia. This kitten was treated twice at a half hourly interval with neostigmine methylsulfate (25 microg) and 5% dextrose (20 ml) iv showed a transient improvement but died 12 h later. A 2-y-old, 4.5 kg male cat was treated s.c. with 1.5 ml ivermectin (15 mg; corresponding to 16.6 times the recommended dose) by its owner and developed slight salivation, lacrimation. mydriasis, protrusion of third eye-lid, tachypnea (42 breaths/min), tachycardia (128 beats/min) and ataxia. The patient was treated with neostigmine methylsulfate (150 microg) and 5% dextrose (100 ml) i.v., and 200 ml of Heartmann's solution i.v. Treatment was repeated after 6 h Follow up treatment over next 2 d was with daily i.v. administration of neostigmine and dextrose. The patient completely recovered 5 d after initiation of treatment.

Animals↗
PubMed2004

Treatment of cutaneous gnathostomiasis with ivermectin.

In a randomized open study, we compared the efficacy of a single dose of oral ivermectin (200 microg/kg) and oral albendazole (400 mg/day for 21 days) for the treatment of cutaneous gnathostomiasis. Thirty-one patients were randomly assigned to receive ivermectin (n = 17) or albendazole (n = 14). Thirteen of 17 patients who received ivermectin responded, 3 relapsed, and 1 was unresponsive (cure rate = 76%). Thirteen of 14 patients who received albendazole responded very well and did not relapse. Only one patient was unresponsive (cure rate = 92%; P > 0.05). No major side effects were observed in both groups. We concluded that a single dose of ivermectin (200 microg/kg) is less effective than albendazole (400 mg/day for 21 days) for treatment of cutaneous gnathostomiasis, but there was no statistically significant difference (P > 0.05).

Administration, Oral↗
PubMed1991

Cumulative mortality rates in Aedes polynesiensis after feeding on polynesian Wuchereria bancrofti carriers treated with single doses of ivermectin, diethylcarbamazine and placebo.

During a therapeutic trial, batches of 672 to 1979 laboratory-bred Aedes polynesiensis, the mosquito vector of lymphatic filariasis in French Polynesia, were fed on Wuchereria bancrofti carriers one, three and six months after they had been treated with either single doses of ivermectin at 100 mcg/kg, diethylcarbamazine (DEC) at 3 and 6 mg/kg or placebo. High mortality rates were observed during the 15-day period following the blood-meal in mosquitoes fed on carriers treated with microfilaricidal drugs and were significantly higher in mosquitoes fed on carriers treated with ivermectin than in those fed on carriers treated with DEC. Though its intensity decreased with the passage of time, the phenomenon was observed in mosquitoes fed on carriers up to six months after treatment, especially in those fed on carriers treated with ivermectin. By decreasing the number of mosquitoes able to transmit the infection, this lethal effect on Ae. polynesiensis might represent an additional advantage of ivermectin in lymphatic filariasis control programs.

Aedes↗
PubMed1991

Efficacy of ivermectin for control of microfilaremia recurring after treatment with diethylcarbamazine. I. Clinical and parasitologic observations.

We compared the efficacy of a single dose of ivermectin with that of a standard course of diethylcarbamazine (DEC) for the control of microfilaremia in 60 patients with bancroftian filariasis who had developed recurrent microfilaremia after each of three or more prior treatments with DEC. The study was done as a randomized, double-blind trial. Complete, but in some cases, transient clearance of microfilaremia was observed in both treatment groups. At one year, recurrent microfilaremia was present in seven patients treated with ivermectin and in five treated with DEC. Pretreatment levels of microfilaremia were significantly higher in patients who relapsed within one year after treatment than in those who remained amicrofilaremic. Side effects with both treatments were common, but mild. Febrile reactions were more frequent in the ivermectin group; localized reactions consistent with a flare-up of acute filarial disease occurred mostly in the DEC group. We conclude that ivermectin is an effective and practical alternative to DEC for treatment of recurrent microfilaremia due to bancroftian filariasis.

Adolescent↗
PubMed1991

Ivermectin inhibits molting of Wuchereria bancrofti third stage larvae in vitro.

The effect of ivermectin or diethylcarbamazine (DEC) on Wuchereria bancrofti molting from the third to the fourth larval stage (L3 to L4) was evaluated in vitro. L3 larvae were harvested from laboratory-reared Aedes togoi 2 wk after feeding upon a microfilaremic human volunteer. The larvae were kept in an artificial medium (Franke's NI medium) with 10% human serum under an atmosphere of 5% CO2 for 20 days. Experimental tubes also contained ivermectin (0.1-1,000 ng/ml) or DEC (0.1-10,000 ng/ml). An estimated concentration of 50 ng/ml ivermectin inhibited molting in 50% of the larvae expected to molt. For DEC, this value was roughly 1,000 ng/ml. In this in vitro culture system, ivermectin inhibited the L3 to L4 molt of W. bancrofti and was roughly 20-fold more potent in this activity than DEC.

Animals↗
PubMed1991

Improvement in severe onchocercal skin disease after a single dose of ivermectin.

PURPOSE: Skin disease is the most common clinically important manifestation of onchocerciasis. Ivermectin, a newly available drug, is well tolerated and effective in Onchocerca volvulus infection. However, little information is available regarding its effect on onchocercal skin disease. The purpose of this study was to examine, in patients with well-characterized onchodermatitis, the effect of a single dose of ivermectin. SUBJECTS AND METHODS: Twenty-one persons with severe onchodermatitis were followed over a 6-month period. In order to evaluate the effect of ivermectin on their skin lesions, photographic transparencies were made before treatment and at 3 and 6 months after treatment. These were then evaluated in a blinded fashion. RESULTS: Following a single dose of 150 micrograms/kg, there was a significant improvement in dermatitis in the first 3 months after treatment. All 14 persons with the worst skin disease showed improvement. The drug had no demonstrable effect on depigmented lesions over the period of observation. Treatment was well tolerated. CONCLUSION: Single-dose ivermectin shows promise as the first acceptable treatment for severe onchocercal dermatitis.

Adolescent↗
PubMed1990

Comparison of the efficacy of dermal formulations of ivermectin and levamisole for the treatment and prevention of Dictyocaulus viviparus infection in cattle.

Four groups of six parasite-naive calves were infected at seven day intervals with three doses of infective larvae of Dictyocaulus viviparus. Twenty-one days after the first dose three of the groups were treated either with an injectable formulation of ivermectin at a dose rate of 200 micrograms/kg bodyweight, or with pour-on preparations of levamisole at 10 mg/kg or ivermectin at 500 micrograms/kg. On day 28 two calves from each group were slaughtered and their burdens of lungworms counted. On day 35 the remaining calves were reinfected with D viviparus infective larvae at a rate of 80 L3/kg. The levamisole preparation was 94.6 per cent effective and both ivermectin preparations were 100 per cent effective against the initial infections. The ivermectin-treated calves were protected from the reinfection which subsequently became patent in the levamisole-treated and control calves.

Administration, Topical↗
PubMed1990

Ivermectin--clinical trials and treatment schedules in onchocerciasis.

Initial clinical trials with ivermectin were performed in patients with both roundworm infestation and onchocerciasis. Obvious clinical safety allowed for rapid progression through 5-30-50-100-150-200 mcg/kg in infected patients. Initial studies showed some effect at 50 mcg/kg; subsequent double-blind controlled studies, either with placebo or diethylcarbamazine (DEC), confirmed the efficacy of ivermectin as well as further defining its safety profile. Absence of adverse eye findings or serious systemic reactions justified the further open trials. Studies of patients treated at 6, 12, or 18 month intervals showed a long lasting effect of ivermectin in reducing skin microfilaria counts. Phase III studies confirmed safety and efficacy and further refined the dose to 150 mcg/kg every 12 months. Large trials in Liberia and other countries in West Africa, and subsequently under Onchocerciasis Control Program (OCP), included approximately 120,000 persons carefully followed during which few patients with serious adverse experiences were reported. These extensive field trials confirmed the relative safety allowing for broad distribution of ivermectin in programs not able to provide physician monitoring.

Animals↗
PubMed1990

Ivermectin treatment of ocular onchocerciasis.

Ivermectin, a recently developed macrocyclic lactone with broad antiparasitic activity, has been shown by a series of clinical trials to be safe and effective in the treatment of human infection with Onchocerca volvulus. Although it is rapidly microfilaricidal, it does not cause a severe reaction as is seen with diethylcarbamazine treatment. In patients with onchocerciasis, a single oral dose of ivermectin (150 micrograms/Kg) repeated once a year leads to a marked reduction in skin microfilaria counts and ocular involvement, although ivermectin has no known long-lasting effects on the adult worms. With treatment there is no significant exacerbation of either anterior or posterior segment eye disease even in those with severe ocular disease. Treatment leads to a marked and prolonged improvement in ocular status. Because of its safety and efficacy, ivermectin can be used on a mass scale and promises to revolutionize the treatment of onchocerciasis.

Animals↗
PubMed1990

Development, pharmacokinetics and mode of action of ivermectin.

Microorganisms isolated from soil at the Kitasato Institute in Japan were tested in a variety of biological assays in Merck laboratories. One of the cultures was found to be active against a nematode parasite. It yielded a series of novel macrocyclic lactones, named avermectins, which proved active against a variety of nematode and arthropod parasites. An extensive programme of chemical modification resulted in the selection of ivermectin (22,23-dihydro-avermectin B1) for commercial development. The producing organism is a new actinomycete species, Streptomyces avermitilis. Strain selection and fermentation improvement were necessary to scale-up from laboratory flasks to 50,000 L fermentors. Using tritium-labelled drug it was shown that ivermectin is absorbed rapidly after oral or parenteral dosing and is excreted almost entirely in the faeces. Pharmacokinetic behaviour depends upon formulation and route of administration. Residues are highest in liver and fat and lowest in brain. Ivermectin has a high therapeutic index in target animals. Idiosyncratic toxicity has been observed in certain strains of dog at more than 8-fold the recommended dose of 6 ug/kg. Ivermectin causes paralysis in susceptible parasites. It is believed that this is the result of lowered cell membrane resistance produced by increased chloride ion influx.

Animals↗
PubMedDate not supplied

Ivermectin against larval stages of Dirofilaria repens in dogs.

The prophylactic efficacy of ivermectin against Dirofilaria repens infections in dogs was investigated. A first trial was carried out on 15 dogs exposed to four inoculations of L3 larvae at 15-day intervals and treated, in groups of five, with 0, 6 or 12 micrograms/kg body weight of ivermectin given per os 30 and 60 days after the first inoculation. Necropsy, performed about 9 months later, revealed that worm burdens were reduced by 86.6 and 92.8% for the 6 and 12 micrograms/kg dose levels, respectively. In a second trial with an otherwise identical protocol, a dose rate of 24 micrograms/kg of ivermectin was tested in 12 dogs. Only one of the six treated dogs was found worm free at necropsy. The worm burden was reduced by 87.9% in treated animals as opposed to controls. A lengthening of the prepatent periods, which might be considered dose related, was apparent in all treated groups. Ivermectin was not completely effective in preventing establishment of experimental infections with D. repens in dogs.

Animals↗