Approach

Management recommendations are largely based on case-control studies and expert opinion.

Treatment of trichinellosis includes the use of anthelmintic antiparasitic drugs and corticosteroids, as well as symptomatic and supportive therapy.[2]​​[34]​​​​​[65] CDC: clinical overview of trichinellosis Opens in new window

Mild cases can be treated in the outpatient setting. Moderate and severe cases require admission to the hospital until they are stable and there is evidence of frank improvement of any respiratory, cardiac, or neurologic manifestations.

Nonpregnant adults

The mainstay of treatment for uncomplicated cases of trichinellosis in nonpregnant adults is an anthelmintic with symptomatic and supportive therapy. Corticosteroids administered concomitantly with anthelmintics may alleviate acute symptoms and be life-saving in all patients with severe disease.​[34][65]​​

Uncomplicated disease

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] However, diagnosis during the enteral phase is uncommon. Many cases will be diagnosed when larvae have disseminated to the skeletal muscles (approximately 4 weeks post infection) reducing the likelihood of complete eradication of the parasite. A prolonged course of anthelmintic therapy may be required if treatment is not initiated during the first few days following infection.[34] Albendazole or mebendazole (benzimidazole class anthelmintics) are the preferred first-line agents in nonpregnant adults​.[34]

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

Severe and complicated infection

Patients with severe infection may benefit from corticosteroid treatment.​[34][65]​​ Corticosteroids (e.g., prednisone) administered concomitantly with anthelmintics may alleviate acute symptoms and be life-saving in all patients with severe disease, particularly when the central nervous system or heart is involved.[34] The use of corticosteroids in trichinellosis is based on expert opinion; controlled studies are lacking.[65][70]

Symptomatic and supportive therapy

Limited bed rest, nonsteroidal 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.

Management of complications

Treatment of any complication should be initiated. Correcting hypokalemia is particularly important in patients with severe disease who develop myocarditis. Antiarrhythmics 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.

Pregnant women

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 due to its minimal systemic absorption, but it 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]

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

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

Children

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] Consult a specialist for guidance on treatment options in this age group.​

Children ≥2 years of age are treated with albendazole or mebendazole.[34]​ 

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

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