Treatment of anisakidosis with drugs

Helminths, although they do not wish harm to the body of their host, still bring it, so you need to get rid of such a neighborhood as soon as possible. Alas, work on the development of effective methods of treating anisakiasis has been going on for many years, but so far science has not confirmed the sufficient effectiveness of any of the known antihelminthic drugs.

In treating the disease, doctors attempt to reduce the activity of anisakid larvae using synthetic drugs such as Albendazole, Mebendazole, Zentel, Mintezol, etc. The standard dosage is 400 mg twice a day, and the course of treatment ranges from 1 to 3 weeks.

But if you read the instructions for these drugs, none of them mentions anisakiasis, much less treatment regimens and dosages. It turns out that doctors act at random if the patient still prefers drug therapy. In addition, drugs for the treatment of helminthiasis are quite toxic, can have a teratogenic effect on the fetus, so they are not recommended for the treatment of pregnant women and small children.

It is important to understand that even if it is possible to get rid of nematode larvae with medication or endoscopy, the internal walls of the gastrointestinal tract organs remain severely damaged, and the situation is aggravated by hypersensitivity reactions associated with helminth infection. Traditional antispasmodics can be used to relieve pain in anisakiasis, and enveloping agents and anticides can be used to protect and heal the gastrointestinal mucosa. Antihistamines help reduce the manifestations of allergic reactions.

If the use of the above medications does not help relieve inflammation (for example, with severe and multiple damage to the mucous membrane), seek help from systemic glucocorticosteroids, which have a pronounced anti-inflammatory effect, relieve swelling and irritation.

We have already said that the accumulation of anisakid larvae in the intestinal lumen can provoke its obstruction. In this case, there is no time to waste, and the destruction of parasites can take quite a long time. In this case, doctors resort to surgical intervention - resection of the affected area of the intestine.

It is important to understand that anisakid worms are not simple worms that are easily detected in feces and excreted from the body. It is not possible to objectively assess the effectiveness of anisakidosis treatment. The doctor relies on the patient's subjective opinion about his condition, because, as we already know, tests in this case are uninformative, and even with FGDS, it will be problematic to identify and destroy all the larvae.

The only option is a year-long dispensary registration, which involves regular visits to a parasitologist or infectious disease specialist, general and biochemical blood tests, and repeated FGDS.

Drug therapy for anisakiasis

We have already mentioned that an effective universal treatment regimen for the parasitic disease caused by nematodes of the Anisakidae family has not been developed to this day. Most antiparasitic drugs used for various helminthiases have not shown the expected effectiveness. Moreover, in some patients their use provoked the migration of Anisakidae larvae to other organs.

But since there are no other drugs to combat nematodes today, scientists continue to test various treatment regimens and dosages of existing drugs. Thus, cases of successful elimination of anisakids have been reported in connection with the use of the drug "Albendazole".

"Albendazole" is an antiprotozoal (affects protozoa by inhibiting protein synthesis in cells and destroying cell membranes) and anthelmintic drug. Although there is no information about the sensitivity of anisakid to this drug in the instructions, it is attractive that the drug can affect parasites at any stage of their life cycle, destroying both intestinal and intra-tissue "guests". [ 1 ]

For various parasitic infections, therapeutic regimens varying in duration of treatment and daily dosage are used. Usually, one or two tablets of Albendazole are prescribed per day at a dosage of 400 mg during meals. When treating anisakiasis, the pathogen of which has a certain resistance to traditional anthelmintic drugs, doctors tend to prescribe maximum doses (400 mg twice a day).

The course of treatment may vary significantly depending on the rate at which symptoms of the disease disappear and the results of repeated FGDS, but it will still be longer than with other local parasitic infections, which can be dealt with in 1-5 days.

Contraindications to the drug may include hypersensitivity to the active substance or auxiliary components of the drug, retinal diseases, and the severe rare disease phenylketonuria. The drug is not prescribed to children under 3 years of age and pregnant women, as it has a teratogenic effect on the fetus. The drug can be taken at the stage of pregnancy planning, but conception in this case should occur no earlier than 1 menstrual cycle after the end of anisakiasis therapy. During treatment, you will have to stop breastfeeding.

The drug has many side effects. Gastrointestinal reactions are largely similar to the symptoms of the disease itself: nausea, vomiting, abdominal pain, flatulence, bowel disorders, as well as heartburn, dry mouth, and stomatitis. While taking the drug, blood pressure and heart rate may increase, various sleep disorders (increased sleepiness or insomnia), headaches, dizziness, hallucinations may occur, and blood composition may change. Convulsions and visual impairment, fever, bone and joint pain, allergic and anaphylactic reactions are also possible.

The drug has a negative effect on the liver and kidneys, which may be accompanied by corresponding symptoms indicating a dysfunction of the organs.

In general, antiparasitic therapy with drugs intended for this purpose, which have a certain level of toxicity, is little more pleasant than the helminthiasis itself.

In order to somehow alleviate the condition of patients with anisakiasis and reduce the negative consequences of irritation and damage to the gastrointestinal mucosa, doctors prescribe the same drugs as for inflammatory gastroenterological diseases: antacids, enveloping agents, antispasmodics, antiemetics, and, in case of damage to the pancreas or severe inflammation of the stomach, also enzyme preparations.

To relieve pain and spasms caused by irritation of the sensitive lining of the stomach, doctors usually prescribe No-shpa (domestic analogue – Drotaverine). This drug has a relaxing effect on the smooth muscles of the gastrointestinal tract, without having a decisive effect on the work of the heart and blood vessels.

The standard dose of the drug for adult patients is 3-6 tablets (120-240 mg). The daily dose is usually divided into 2 or 3 doses. In the treatment of children over 6 years old and adolescents over 12 years old, dosages of 80 and 160 mg are used, respectively.

The drug has few contraindications. These include hypersensitivity to its components, as well as severe liver, kidney or heart diseases that are accompanied by impairment of their performance.

The antispasmodic has virtually no side effects. Allergic reactions, decreased blood pressure or increased heart rate, headaches and insomnia, nausea and bowel disorders are the symptoms that were noted in isolated cases and cannot be considered statistics.

To speed up the healing of the mucous membrane, antacids with an enveloping effect are considered the most suitable, which protect the inner lining of the gastrointestinal tract from additional irritation. However, such agents do not act on parasites in any way, so their use gives better results after preliminary removal or destruction of helminth larvae.

One of the popular, favorite antacids of enveloping and acid-reducing action among gastroenterologists is "Phosphalugel". In addition to the above properties, the drug is characterized by an absorbent effect, which helps to reduce the toxic effect of antiparasitic drugs and nematode waste products on the body. True, provided that the interval between taking "Phosphalugel" and other drugs is at least 1.5-2 hours. Otherwise, the antacid will reduce the absorption and effectiveness of oral drugs.

Most often, such drugs are used in the treatment of gastrointestinal diseases that occur against the background of increased acidity of the stomach, but in intestinal infections, intoxications, anisakiasis and other parasitic diseases with damage to the inner lining of the digestive organs, "Phosphalugel" provides an invaluable service. It helps to extinguish excess acid with its irritating effect, and also forms a film, protecting the already damaged walls of the gastrointestinal tract from additional irritation, reducing pain resulting from inflammation and irritation of nerve endings, flatulence and other symptoms of the disease.

The drug is available in a convenient form - single-use sachets that need to be crushed beforehand, cut off the corner and squeezed out into a spoon or glass. The gel has a rather pleasant sweet taste and is used in its pure form, but it can also be diluted with a little water.

The drug is prescribed for anisakiasis 2 or 3 times a day. A single dose is 1-2 sachets (no more than 6 sachets per day). An antacid is prescribed 1-2 hours after eating, as well as when pain intensifies. The course of treatment depends on the rate of healing of the mucous membrane, but it should not exceed 14 days.

It is not recommended to use the drug in case of hypersensitivity to its components, Alzheimer's disease, severe epigastric pain of unknown origin, constipation and chronic diarrhea. Exceeding the recommended doses of the drug is fraught with constipation, intestinal obstruction, and impaired renal function in patients suffering from severe pathologies of this organ. To avoid constipation, it is recommended to drink more water during treatment.

The second most common side effect is allergic reactions, which, however, only occur in people with increased sensitivity to individual components of the drug. Sorbitol in the drug can cause diarrhea in some patients.

Since many people have anisakiasis against the background of general sensitization of the body with the development of mild and severe allergic reactions, doctors consider it necessary to include antihistamines (antiallergic) drugs in the treatment regimen. According to most researchers, the most effective and safe drugs today are loratadine and its derivatives.

"Fribris" is a modern antihistamine drug with anti-inflammatory action based on desloratadine, which is devoid of side effects inherent in drugs of previous generations. The drug is produced in the form of tablets and syrup, which makes it possible to use it in the treatment of small children. [ 2 ]

Adult patients and adolescents over 12 years of age can be prescribed the drug both in tablets and in the form of syrup. A single (also daily) dose of the drug is 1 tablet or 10 ml of syrup.

Children aged 6-12 years are given 5 ml of syrup once a day, children aged 2-6 years are given 2.5 ml, regardless of food intake.

The course of treatment with the drug does not exceed 2 weeks.

Like other drugs, Fibris is not prescribed to patients with hypersensitivity to the components of the drug. The syrup contains sugar, so it is not recommended for patients with diabetes. Pregnant women should not take the drug because of its ability to penetrate the hematoplacental barrier.

Women with infants will have to stop breastfeeding for the duration of treatment, and it will be possible to resume it no earlier than 2-3 days after taking the last dose of the drug.

The modern antihistamine has few side effects, so treatment with it is easily tolerated by most patients. In isolated cases, there were complaints of dry mouth, headaches and increased fatigue, which may also be a symptom of the disease. There were also reports of tachycardia, increased heart rate, liver failure, but such episodes were also few.

The most unpleasant thing is that even compliance with all the doctor’s requirements regarding the multi-component treatment regimen for anisakiasis does not guarantee getting rid of the pest and a complete cure.

Folk remedies

The difficulties of diagnosing the disease and the lack of 100% effective treatment regimens for unusual helminthiasis do not confuse people who are actively looking for their own ways to solve the problem. But in this situation, we need to talk not so much about finding new ways, but about using old proven methods of treating worms for anisakiasis.

Usually, worms are understood to mean the popular pinworms. Most people probably suffered from this helminthiasis in childhood (and more than once). But the fact is that despite the external similarity of roundworms, pinworms and anisakids are completely different parasites with different sensitivity to the aggressive influence of environmental factors.

Popular folk methods of combating pinworms, such as eating garlic and a large amount of pumpkin seeds, are unlikely to work on anisakid larvae, which are not affected by either gastric acid or potent synthetic drugs. The suggestion to treat helminthiasis with black and hot pepper is also not supported by doctors (just think about the effect that hot substances can have on the inflamed gastrointestinal mucosa!), in addition, such options for combating nematodes will most likely contribute not to the expulsion of parasites, but to a change in their localization, for example, penetration into other organs.

Herbal treatment, used for many helminthiases, does not help with anisakiasis. Usually, bitter herbs are used to expel worms: wormwood, tansy, celandine and others. But the problem is that most of these herbs in high concentrations are highly toxic, and instead of benefit, can cause significant harm to human health. And standard dosages do not give the expected effect.

It's a different matter if herbs are used as an anti-inflammatory, as is done in gastroenterology. Chamomile, plantain, St. John's wort, yarrow, calendula, nettle are common herbs that will help relieve pain and inflammation in the gastrointestinal tract faster, speed up the healing of small wounds on the walls of organs, and dill seeds, mint, lemon balm, thyme will help to quickly cope with flatulence and reduce discomfort in the abdomen. [ 3 ]

Homeopathy

Numerous studies have been conducted to date, but there is no convincing evidence that homeopathic medicines are clinically different from placebo. Until more convincing research results are obtained, homeopathy cannot be considered an evidence-based form of therapy. [ 4 ], [ 5 ], [ 6 ]

Homeopathy is currently the branch of alternative medicine that is the main competitor to classical treatment. More and more people are inclined to think that it is not necessary to poison your body with chemicals to treat most diseases. This also applies to helminthiasis, the drugs for the treatment of which are known to be toxic.

But the situation is that homeopaths also do not have effective drugs for anisakiasis, although many other helminthiases can be treated with specific and constitutional remedies.

The issue of treating helminthiasis with homeopathy is actively discussed on Internet forums. Usually, the suggestions sound like this: “I found a scheme according to which helminthiasis was treated in a girl” or “this drug removed worms from me and my children”. That is, people do not understand the difference between worms and other nematodes and do not realize that approaches to treating different helminthiasis will be different. Not to mention the fact that homeopathic treatment does not have specific schemes at all and is prescribed individually.

On the Internet, you can find references to various antiparasitic drugs based on homeopathic ("Gelminton", "Gelmintol") and herbal ("Intoxic", "Antiparasite") components. But having studied the descriptions of these drugs, you can see that there is again no mention of anikazid. Whether it is worth testing the effectiveness of such drugs on yourself, everyone decides for themselves, but doctors are extremely skeptical or even negative about such experiments.