What are guideline-recommended antiparasitic regimens and dosages for Ascaris, Fasciola, and Echinococcus infections?
Executive summary
Clinical guidelines converge on simple, highly effective single‑dose oral regimens for intestinal Ascaris and on specific, non‑praziquantel therapy for fascioliasis, while management of human echinococcosis is complex, guided by WHO algorithms that combine antiparasitic drugs with interventional approaches; the precise antiparasitic choices and doses differ by parasite and clinical scenario [1] [2] [3]. Available source material gives clear, cited doses for Ascaris and a regimen recommendation for Fasciola, but the WHO guidance for echinococcosis [3] is referenced without detailed dosage snippets in the provided reporting.
1. Ascaris lumbricoides — standard, single‑dose anthelmintics that work
Consensus clinical reviews list albendazole, mebendazole and ivermectin as effective first‑line oral options for uncomplicated intestinal ascariasis: albendazole 400 mg orally as a single dose; mebendazole either 100 mg orally twice daily for 3 days or 500 mg orally once; and ivermectin at 150–200 mcg/kg orally as a single dose — all recommended to treat all intestinal infections to prevent complications and used widely in individual and public‑health programs [1] [4] [5]. Randomized trials and systematic reviews support high cure rates and large egg‑count reductions with single‑dose albendazole, mebendazole or ivermectin and report similar efficacy and acceptable safety profiles across ages studied, although some sources advise caution for certain age groups or pregnancy with benzimidazoles [4] [5] [6]. National clinical resources and specialty guides echo these regimens and note the role of community deworming in endemic settings [7] [8] [9].
2. Fasciola hepatica/gigantica — triclabendazole is the drug of choice; praziquantel is ineffective
Authoritative treatment summaries and the CDC identify triclabendazole as the recommended drug of choice for human fascioliasis and describe a two‑dose regimen as standard, noting triclabendazole’s FDA approval in recent years after long availability through public health channels; importantly, praziquantel does not work against Fasciola and is not recommended [2] [10]. Reports also flag emerging triclabendazole resistance in animal hosts and suggest nitazoxanide as a possible alternative in limited evidence scenarios, but the CDC‑backed recommendation remains the two‑dose triclabendazole schedule for human cases [2] [10]. The provided excerpts do not contain weight‑based milligram dosing details for triclabendazole, so precise mg/kg recommendations cannot be quoted from these sources here [2].
3. Echinococcus (cystic and alveolar) — WHO guidance governs a nuanced, case‑by‑case approach
WHO guidance documents frame human echinococcosis as a group that includes cystic echinococcosis (E. granulosus s.l.) and alveolar echinococcosis (E. multilocularis), and they provide algorithmic recommendations that integrate antiparasitic therapy with surgery or percutaneous techniques depending on cyst stage, location and species [3]. The supplied WHO reference establishes the clinical taxonomy and the existence of guideline algorithms but the provided snippets do not include explicit drug regimens or dose schedules in milligrams; therefore, specific dosing recommendations from WHO cannot be quoted from the available reporting [3]. Secondary pharmacology reviews note that many cestode and trematode infections respond to praziquantel, but that larval Echinococcus infections are exceptions to that pattern and require different antiparasitic management — an implicit reminder that echinococcosis treatment is pathogen‑ and stage‑specific and not a one‑size‑fits‑all praziquantel course [10].
4. Practical caveats, evidence limits and competing priorities
Guideline excerpts and systematic reviews make clear that ascariasis regimens are simple and well‑supported by trials, whereas fascioliasis and echinococcosis require specialist input: triclabendazole is recommended for Fasciola but resistance and alternative agents have been reported, and WHO’s echinococcosis guidance emphasizes individualized care combining drugs and procedures [4] [2] [3]. The current reporting provides firm, citable doses for Ascaris and a regimen statement for Fasciola but does not include detailed weight‑based milligram tables for triclabendazole or the WHO‑specified antiparasitic dosages and timing for cystic or alveolar echinococcosis in the excerpts supplied, so those precise numbers cannot be reproduced here [2] [3]. Clinicians should consult full CDC and WHO treatment documents or specialist infectious‑disease/hepatobiliary services for patient‑specific dosing, monitoring and procedural decisions.