Latest guidelines on treatment and prevention of toxocariasis from the Ministry of Health of Vietnam

Main Content

Latest guidelines on treatment and prevention of toxocariasis from the Ministry of Health of Vietnam

Based on Section 5 of the Guidance on Diagnosis, Treatment, and Prevention of Toxocariasis issued together with Decision 1385/QD-BYT in 2022, the methods for treating toxocariasis are as follows:

- Principle of treatment: Specific medication combined with symptomatic treatment.

- Specific treatment: Use one of the medications in the priority order below:

Regimen 1: Albendazole (200mg and 400mg tablets)

a) Dosage

- Adults: 800mg/day/person, divided into 2 doses per day.

- Children > 1 year old: 10-15mg/kg/day (maximum 800mg), divided into 2 doses per day.

b) Treatment according to disease form

- For the common form: each course lasts 14 days.

- For visceral, ocular, nervous forms: each course lasts 21 days. For the ocular form, the patient may be referred to an ophthalmologist for surgery as indicated.

c) Contraindications of Albendazole

- Individuals with a history of hypersensitivity to benzimidazoles.

- Pregnant or breastfeeding women.

- Children < 1 year old.

- Individuals with a history of bone marrow toxicity.

d) Notes

- Use caution when administering Albendazole to patients with liver or kidney impairment.

- Adverse effects of Albendazole include granulocytopenia, agranulocytosis, various hematologic deficiencies, and liver function impairment with prolonged use. Therefore, blood and liver function tests (transaminase levels) should be conducted at the beginning of each treatment cycle and at least every two weeks during treatment. If liver enzymes rise significantly, Albendazole should be discontinued. Treatment can be resumed if liver enzymes return to pre-treatment levels, with more frequent testing during retreatment.

Regimen 2: Thiabendazole (500mg tablets)

a) Dosage: 2 doses/day for 7 days, according to the patient's weight (see table).

b) Treatment according to disease form: applicable for visceral and common forms.

c) Contraindications: hypersensitivity to the components of the medication.

d) Precautions

- Patients with liver or kidney impairment;

- Pregnant women in the first trimester and breastfeeding mothers;

- Do not operate machinery or drive vehicles;

- Children under 12 months old or weighing less than 13.6kg.

Regimen 3: Ivermectin (3mg and 6mg tablets)

a) Dosage: adults and children ≥ 5 years old: 0.2mg/kg x 01 dose/day for 1-2 days;

b) Treatment according to disease form

+ For larvae migrating within the skin and soft tissues, the medication responds well to the recommended dose and may be repeated if not cured.

+ For larvae migrating in the eyes or visceral organs, consider ivermectin treatment. It can be used after or simultaneously with corticosteroids to reduce the clinical exacerbation. Combine with symptomatic treatment.

c) Contraindications

+ Patients sensitive to any components of the medication.

+ Patients with meningitis.

+ Pregnant or breastfeeding women.

+ Children under 5 years old or weighing < 15kg.

d) Notes when using the medication

+ Administer away from meals, 1-2 hours before or after eating;

+ Use caution for individuals operating vehicles or machinery.

+ Adverse effects of ivermectin include fever, itching, skin redness, joint pain, muscle pain, lymph node pain, tachycardia, etc.

- Symptomatic treatment

Based on clinical symptoms, prescribe appropriate medication:

+ Itching, hives: use antihistamines until symptoms subside;

+ Fever: antipyretics and mechanical cooling;

+ Supportive medication: probiotics, multivitamins, liver supplements, iron tablets as necessary.

- Surgical treatment: In cases where larvae migrate within the skin, soft tissues, or eyes, surgical intervention may be indicated.

- Follow-up after treatment: Organize treatment for the patient with a maximum of 3 courses, with each course 1 month apart. After each course, evaluate parameters: clinical symptoms, ELISA, blood count, liver and kidney function. If improvement is clear, treatment can be stopped. If not, continue with courses 2 and 3 with similar dosages as course 1. After three courses, if symptoms do not improve, reassess the diagnosis and conduct additional or repeat tests for a more appropriate diagnostic and treatment direction.

Latest guidelines on treatment and prevention of toxocariasis from the Ministry of Health of Vietnam

Criteria for curing toxocariasis in Vietnam

Based on Section 6 of the Guidance on Diagnosis, Treatment, and Prevention of Toxocariasis issued together with Decision 1385/QD-BYT in 2022, the criteria for curing the disease are as follows:

- Clinical symptoms reduce or disappear after treatment;

- ELISA test shows a decrease in antibody titer or return to negative;

- Eosinophil percentage and total IgE decrease or return to normal values.

Prevention of toxocariasis in Vietnam

Based on Section 7 of the Guidance on Diagnosis, Treatment, and Prevention of Toxocariasis issued together with Decision 1385/QD-BYT in 2022, the methods of prevention are as follows:

- Regular deworming for dogs and cats. For puppy and kitten deworming, administer the first dose immediately when they are 2-3 weeks old (as puppies and kittens can be infected from their mother before or after birth or through milk, and puppies often shed eggs heavily into the environment), deworming 3 times at intervals of 2 weeks, then repeat every 6 months. Use preventive deworming medication regularly, including puppy and pregnant dogs, to limit disease transmission.

- Environmental hygiene: Sanitize the environment, especially areas with dog and cat feces, areas within the house, and children's play areas.

- Collect and dispose of pet feces immediately to prevent eggs from infected animals.

- Wash hands thoroughly after touching or playing with pets and domestic animals or after exposure to contaminated areas.

- Develop good personal hygiene habits: regularly wash hands with soap before eating, ensure cooked food and boiled water consumption. Clean children's play areas thoroughly.

- Educate and raise awareness about personal and community hygiene, protecting the environment from dog and cat feces contamination.