rcdavis Posted February 23, 2014 Share Posted February 23, 2014 Had a patient who came in with what was shown to be ascariasis ... She passed an 8 inch worm that morning. Vernon 100mg bid x 3d was prescribed. Pharmacy called me and told me the surprising news that vermox is now no longer available. I have never prescribed ivermectin ( second choice), so I referred to infectious dz. But I wonder, what are you all using to treat pinworms now that vermox is MIA? Link to comment Share on other sites More sharing options...
bradtPA Posted February 23, 2014 Share Posted February 23, 2014 Pyrantel over the counter can work for pinworms..... Link to comment Share on other sites More sharing options...
cupojava Posted February 23, 2014 Share Posted February 23, 2014 Albendazole. Link to comment Share on other sites More sharing options...
rcreek Posted February 23, 2014 Share Posted February 23, 2014 Pyrantel over the counter can work for pinworms..... OTC pyrantel pamoate is also effective against roundworms, hookworms, whipworms, and even tapeworms. It is known as a broad-spectrum de-wormer in vet circles. It works as a paralyzing agent in helminths. I know because I bought some for myself at the University pharmacy when I returned home from a vacation in Fiji. Okay, here's the story... I don't know if I actually got worms, but I worked myself up when I realized what I had done to put myself at great risk after vacationing in Fiji. Fiji has one of the highest rates of ascariasis in Oceania. Rather than lounge at the resort all day, I wandered off and fished for several days with local Fijians in a freshwater river, barefoot, cutting up raw fish for bait, etc. Then I started thinking about parasitic infections. Walking barefoot in a tropical, third-world country... where ascariasis is so common... in moist soil and mud... along a river delta where locals take care of their business... perfect recipe for ascariasis. Roundworm larvae burrow through the skin of barefeet and enter the circulatory system, where they cross into the alveoli of the lungs and are coughed up, swallowed, and develop into adults in the GI tract. I think I went through two bottles of pyrantel pamoate in the following weeks. Figured that would be better than waiting so see a worm in the toilet one day. Not trying to become a story on Monsters Inside Me (great show by the way). Also got bit by mosquitoes. I later learned that I was there during the start of a little outbreak of dengue fever. Got lucky I guess. Link to comment Share on other sites More sharing options...
Will352ns Posted February 23, 2014 Share Posted February 23, 2014 2nd Albendazole. I carried this while I was in the military. Used it to treat indigenous and my guys. Easy dosing, good effectiveness....doesn't cost too much (if memory serves). Link to comment Share on other sites More sharing options...
Guest Paula Posted February 23, 2014 Share Posted February 23, 2014 Why is vermox no longer available? I've used albendazole and a reference I use states it is the treatment of choice. I've prescribed ivermectin once for resistant pediculosis with a bit of fear and trembling and after a discussion with pharmacist and parents regarding adverse reactions. All turned out ok. One of my references does not list ivermectin as an anthelminthic agent. My daughter-in-laws sister was treated for appendicitis two years ago and at surgery the appendix was found to be full of pinworms. This topic makes me sqwormy. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 23, 2014 Share Posted February 23, 2014 ^^^. Now THIS is what makes medicine fun. Link to comment Share on other sites More sharing options...
Acebecker Posted February 23, 2014 Share Posted February 23, 2014 I have used ivermectin a couple of times in resistant scabies infestation as it was the only med we had on formulary at our IHS clinic. I have read up on the potential SEs and common ADRs with it. I have to ask - how is it worse than antibiotics or statins? Link to comment Share on other sites More sharing options...
Guest Paula Posted February 23, 2014 Share Posted February 23, 2014 @Ace: Not sure if it is any worse than ABXs or statins as all 3 drugs have fairly long list of serious adverse reactions. I compared atorvastatin, amoxicillin and invermectin and all have similar ADRs. I just get a little nervous the first time I prescribe a drug and hope all is well. You know how it is..... We prescribe ABXs and statins daily in FP and rarely see serious ADRs so we become comfortable with the drug and can counsel patients on side effects. I've seen about 3-4 cases of serum sickness/TEN/SJS type of reactions with antibiotics in the 10 years I've been in practice. None prescribed by me as they were patients I saw in UC/ER. Who knows if what I have prescribed ended up the same way in UC/ERs I don't work in!!!! You make a good point. Is it just me that gets nervous prescribing a drug we are not completely familiar with? I am going to start a new thread on this question. Link to comment Share on other sites More sharing options...
Acebecker Posted February 23, 2014 Share Posted February 23, 2014 Paula - I just wanted to make sure I wasn't overlooking something. I can miss the elephant in the room on occasion. Link to comment Share on other sites More sharing options...
Guest Paula Posted February 24, 2014 Share Posted February 24, 2014 Nope, don't think so. Link to comment Share on other sites More sharing options...
skyblu Posted February 28, 2014 Share Posted February 28, 2014 I've never treated worms in the ED, so this is all educational to me. Although I think I'm about to vomit. I can deal with pretty much anything, the grosser the better, but parasites freak me out. Ivermectin is what my dog got to deworm him as a puppy, I believe. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 28, 2014 Share Posted February 28, 2014 Don't forget to prescribe the Scotch branded tape for nocturnal application. They are an official sponsor for this issue and as such will cost 4x's as much as the competing branded tape (yes, I'm being silly). Link to comment Share on other sites More sharing options...
AREID Posted February 28, 2014 Share Posted February 28, 2014 Like ACEbecker iv only prescribed it for resistant scabies infection and I only did this once. Scabies resolved and no adverse reactions noted. But I feel you Paula on the nervousness whenever handling a new medication Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
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