Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

non-pregnant adults

1st line – albendazole or mebendazole

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ACUTE
|
non-pregnant adults
1st line – 

albendazole or mebendazole

Albendazole or mebendazole are the preferred first-line agents.[34]

Prompt treatment with an anthelmintic, preferably administered during the initial gastrointestinal (enteral) phase, may reduce disease progression by killing adult worms thereby preventing further release of larvae.[34] A prolonged course of anthelmintic therapy may be required if treatment is not initiated during the first few days following infection.[34] Extended therapy with albendazole or mebendazole necessitates serial monitoring of full blood count due to the risk of bone marrow suppression.[34] Liver enzymes should also be monitored during treatment.

Primary options

albendazole: 400 mg orally twice daily for 8-14 days

OR

mebendazole: 200-400 mg orally three times daily for 3 days, followed by 400-500 mg three times daily for 10 days

Plus – supportive therapy

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ACUTE
|
non-pregnant adults
Plus – 

supportive therapy

Treatment recommended for ALL patients in selected patient group

Limited bed rest, non-steroidal anti-inflammatory drugs (NSAIDs), and other analgesics may be helpful for the symptomatic relief of myalgia. Patients must be well hydrated and have electrolyte imbalances corrected.

Initiate treatment of any complications. Correcting hypokalaemia is particularly important in patients with severe disease who develop myocarditis. Anti-arrhythmics and treatment of congestive cardiac failure may be necessary in severe infection complicated by myocarditis. Antibiotics can be given on the rare occasions when trichinellosis becomes complicated by pneumonia or sepsis.

Consider – oral corticosteroid

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ACUTE
|
non-pregnant adults
Consider – 

oral corticosteroid

Additional treatment recommended for SOME patients in selected patient group

Patients with severe infection may benefit from corticosteroid treatment.​[34][65]​ Corticosteroids (e.g., prednisolone) given concomitantly with anthelmintics may alleviate acute symptoms and be life-saving in patients with severe disease, particularly when the central nervous system (CNS) or heart is involved.[34]

The use of corticosteroids in trichinellosis is based on expert opinion; controlled studies are lacking.[65][70]

Treatment course: 10-15 days.

Primary options

prednisolone: 0.5 to 1 mg/kg/day orally, maximum 60 mg/day

pregnant

1st line – specialist consultation

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ACUTE
|
pregnant
1st line – 

specialist consultation

There is no drug available that is considered to be safe and effective for the treatment of trichinellosis in pregnancy. A specialist should be consulted when deciding on suitable anthelmintic therapy for pregnant women.

Pyrantel is considered safe, but is only active against intestinal Trichinella species, and is not effective in the systemic (parenteral) phase of the disease (when the vast majority of cases are diagnosed).[71]

Albendazole has been associated with carcinogenesis in mice and rats, and use during the first trimester is not recommended. It may be used with caution after the first trimester if the benefits outweigh the potential risks.[34]​ One systematic review and meta-analysis of studies of anthelmintics for the treatment of intestinal nematodes found that pregnancy loss and preterm delivery did not differ significantly between albendazole-treated pregnant women and pregnant controls (low-quality evidence).[72] 

Mebendazole, which can cause embryotoxicity and teratogenesis, may be used with caution after the first trimester if the benefits outweigh the potential risks.[34][73] Rate of pregnancy loss did not differ between mebendazole and placebo in a systematic review and meta-analysis of studies of gestational helminth infections (moderate-quality evidence).[72]

Available evidence suggests no difference in congenital abnormalities in the children of women who were treated with albendazole or mebendazole during mass prevention campaigns compared with those who were not.[34]

Plus – supportive therapy

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ACUTE
|
pregnant
Plus – 

supportive therapy

Treatment recommended for ALL patients in selected patient group

Symptomatic and supportive therapy in pregnancy includes limited bed rest, analgesia, hydration, and correction of electrolyte imbalances. NSAIDs are not recommended in pregnancy.[71]

Initiate treatment of any complications. Correcting hypokalaemia is particularly important in patients with severe disease who develop myocarditis. Anti-arrhythmics and treatment of congestive cardiac failure may be necessary in severe infection complicated by myocarditis. Antibiotics can be given on the rare occasions when trichinellosis becomes complicated by pneumonia or sepsis.

Consider – oral corticosteroid

Back
ACUTE
|
pregnant
Consider – 

oral corticosteroid

Additional treatment recommended for SOME patients in selected patient group

Corticosteroids may be considered in pregnant women with severe trichinellosis.[74]

Corticosteroids (e.g., prednisolone) administered concomitantly with anthelmintics may alleviate acute symptoms and be life-saving in all patients with severe disease, particularly when the CNS or heart is involved.​[34][65]​​

The use of corticosteroids in trichinellosis is based on expert opinion; controlled studies are lacking.[65][70]

Treatment course: 10-15 days.

Primary options

prednisolone: 0.5 to 1 mg/kg/day orally, maximum 60 mg/day

children

1st line – pyrantel or mebendazole

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ACUTE
|
children
|
<2 years of age
1st line – 

pyrantel or mebendazole

Children <2 years of age are typically treated with pyrantel or mebendazole.

Although there is little information regarding the use of mebendazole in children <2 years of age, some experts consider its use to be safe.[75] ​However, consult a consultant for guidance on treatment options in this age group.  

Prompt treatment with an anthelmintic, preferably administered during the initial gastrointestinal (enteral) phase, may reduce disease progression by killing adult worms thereby preventing further release of larvae.[34]

Extended therapy with mebendazole necessitates serial monitoring of full blood count due to the risk of bone marrow suppression.[34] Liver enzymes should also be monitored during treatment with mebendazole.

Primary options

pyrantel: consult specialist for guidance on dose

Secondary options

mebendazole: consult specialist for guidance on dose

Plus – supportive therapy

Back
ACUTE
|
children
|
<2 years of age
Plus – 

supportive therapy

Treatment recommended for ALL patients in selected patient group

Symptomatic and supportive therapy with hydration, correction of electrolyte imbalances, limited bed rest, and analgesia.

Initiate treatment of any complications. Correcting hypokalaemia is particularly important in patients with severe disease who develop myocarditis. Anti-arrhythmics and treatment of congestive cardiac failure may be necessary in severe infection complicated by myocarditis. Antibiotics can be given on the rare occasions when trichinellosis becomes complicated by pneumonia or sepsis.

Consider – oral corticosteroid

Back
ACUTE
|
children
|
<2 years of age
Consider – 

oral corticosteroid

Additional treatment recommended for SOME patients in selected patient group

Patients with severe infection may benefit from corticosteroid treatment. Corticosteroids (e.g., prednisolone) administered concomitantly with anthelmintics may alleviate acute symptoms and be life-saving in patients with severe disease, particularly when the CNS or heart is involved.​[34][65]

The use of corticosteroids in trichinellosis is based on expert opinion; controlled studies are lacking.[65][70]

Treatment course: 10-15 days.

Primary options

prednisolone: 0.5 to 1 mg/kg/day orally, maximum 60 mg/day

1st line – albendazole or mebendazole

Back
ACUTE
|
children
|
≥2 years of age
1st line – 

albendazole or mebendazole

Children ≥2 years of age are treated with albendazole or mebendazole.[65]​ 

Prompt treatment with an anthelmintic, preferably administered during the initial gastrointestinal (enteral) phase, may reduce disease progression by killing adult worms thereby preventing further release of larvae.[34]

A prolonged course of anthelmintic therapy may be required if treatment is not initiated during the first few days following infection.[34] Extended therapy with albendazole or mebendazole necessitates serial monitoring of full blood count due to the risk of bone marrow suppression.[34] Liver enzymes should also be monitored during treatment.

Primary options

albendazole: 400 mg orally twice daily for 8-14 days

OR

mebendazole: 200-400 mg orally three times daily for 3 days, followed by 400-500 mg three times daily for 10 days

Plus – supportive therapy

Back
ACUTE
|
children
|
≥2 years of age
Plus – 

supportive therapy

Treatment recommended for ALL patients in selected patient group

Symptomatic and supportive therapy with hydration, correction of electrolyte imbalances, limited bed rest, and analgesia.

Initiate treatment of any complications. Correcting hypokalaemia is particularly important in patients with severe disease who develop myocarditis. Anti-arrhythmics and treatment of congestive cardiac failure may be necessary in severe infection complicated by myocarditis. Antibiotics can be given on the rare occasions when trichinellosis becomes complicated by pneumonia or sepsis.

Consider – oral corticosteroid

Back
ACUTE
|
children
|
≥2 years of age
Consider – 

oral corticosteroid

Additional treatment recommended for SOME patients in selected patient group

Patients with severe infection may benefit from corticosteroid treatment. Corticosteroids (e.g., prednisolone) administered concomitantly with anthelmintics may alleviate acute symptoms and be life-saving in patients with severe disease, particularly when the CNS or heart is involved.​[34][65]

The use of corticosteroids in trichinellosis is based on expert opinion; controlled studies are lacking.[65][70]

Treatment course: 10-15 days.

Primary options

prednisolone: 0.5 to 1 mg/kg/day orally, maximum 60 mg/day

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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