Q: 32-year-old male who recently traveled from Africa after his global health fellowship is admitted to ICU with pulmonary symptoms. Patient gets diagnosed with Strongloidosis and was prescribed ivermectin by ID service. Patient was unable to tolerate ivermectin by central route due to high nasogastric output. What other route is preferred?
Enteral route is preferred for ivermectin but if not feasible it can be given as subcutaneously. Although rectal route is also suggested, it may not achieve an effective serum level.
1. Barrett J, Broderick C, Soulsby H, et al. Subcutaneous ivermectin use in the treatment of severe Strongyloides stercoralis infection: two case reports and a discussion of the literature. J Antimicrob Chemother 2016; 71:220.
2. Bogoch II, Khan K, Abrams H, et al. Failure of ivermectin per rectum to achieve clinically meaningful serum levels in two cases of Strongyloides hyperinfection. Am J Trop Med Hyg 2015; 93:94.