Features of therapy for parasitic infestations in children

Who is allowed or prohibited from taking Vermox?

The abstract recommends therapy if:

• alveococcosis;
• hookworm;
• ascariasis;
• capillariasis;
• strongyloidiasis;
• taeniasis;
• trichinosis;
• trichocephalosis;
• enterobiasis;
• echinococcosis.

Vermox exhibits sufficient activity against mixed helminthiasis.

The drug is contraindicated in patients:

• with liver failure;
• ulcerative colitis;
• intolerance to the component composition;
• Crohn's disease.

The medication is prohibited for use in children under 2 years of age, pregnant and lactating women.

Adverse reactions

The instructions indicate that therapeutic procedures with Vermox may cause the development of non-standard responses of the body. Common side effects include:

• discomfort in the abdominal area;
• dizziness and nausea;
• dyspeptic disorders;
• cephalgia, active hair loss;
• dermatological rash, Quincke's edema;
• increased creatinine levels;
• the appearance of cylinders and blood particles in urine;
• increased activity of liver enzymes;
• anemic conditions.

Laboratory diagnostics may reveal a decrease in the number of white blood cells and eosinophils in blood tests.

Therapy methods

The instructions for the tablets indicate that Vermox should be taken after meals. The dosage of the medication depends on the type of pathological process occurring:

• enterobiasis - for patients over 10 years of age and adults: a single dose of 100 mg, if there is a risk of relapse, repeated therapy is prescribed after 14 days in a similar dosage;
• ascariasis, mixed helminthiasis, etc. – 100 mg twice a day for three days;
• trichinosis - from 200 to 400 ml daily, for 72 hours, from 4 to 10 days - from 400 to 500 mg of medication.

The annotation states that for the first 24 hours after the procedure, the patient should abstain from alcoholic beverages, fatty foods and laxatives. After completion of therapy, laboratory diagnostics are needed to determine the presence of eggs and adult helminths (carried out within a week). Long-term measures to combat parasitic organisms require regular checks of blood composition, kidney and liver functionality.

Treatment of children

Children more often suffer from enterobiasis, ascariasis, and giardiasis. Pathological processes are registered within certain age limits, the problem arises:

• due to enzyme deficiency;
• deviations in the acid-base balance of the gastrointestinal tract;
• immature motor skills;
• unstable intestinal microflora.

A child’s body becomes vulnerable after suffering from intestinal diseases and undergoing therapy with antibacterial drugs. Treatment procedures are carried out in accordance with the dosages and recommendations from the instructions for Vermox:

1. Ascariasis - from 2 to 10 years, 0.5 g per day, over 11 years - 0.1 g per day. The total amount of medication is divided into three procedures. Therapy takes no more than 3 days.
2. Enterobiasis - in the period of 2-5 years, a quarter of a tablet, 5-10 years - 0.5 tablets, after 11 years - a whole tablet. The medicine is given once a day, a second course is prescribed after a two-week break, maintaining the original dosage.

During medical procedures, it is necessary to wash underwear at high temperatures - above 90 degrees. The rule applies not only to the clothing of a sick child, but also to all family members.

Vermox 100 mg No. 6 tablet.

Instructions for medical use of the drug VERMOX Trade name Vermox International nonproprietary name Mebendazole Dosage form Tablets 100 mg Composition One tablet contains the active substance - mebendazole 100 mg excipients: sodium lauryl sulfate, colloidal anhydrous silicon dioxide, magnesium stearate, sodium saccharin, talc, corn starch, lactose monohydrate. Description Tablets, white or almost white, flat, disc-shaped with a bevel, with the inscription “Vermox” on one side and a score on the other, with a slight characteristic odor, about 10.0 mm in diameter. Pharmacotherapeutic group Preparations for the treatment of nematodes. Benzimidazole derivatives ATC code P02 CA 01 Pharmacological properties Pharmacokinetics Poorly absorbed after oral administration. The bioavailability of a conventional anthelmintic dose is insufficient due to low solubility and intensive primary metabolism. 90% of the absorbed fraction binds to plasma proteins. Bioavailability increases when taking the drug simultaneously with fatty foods. It is excreted mainly unchanged in feces. Pharmacodynamics Broad-spectrum antihelminthic agent. It disrupts the tissue respiration of worms and causes degeneration of the cytoplasmic microtubules of the worm, prevents the utilization of glucose, reduces energy metabolism, reduces the formation of ATP in tissues and thereby causes irreversible muscle paralysis and death of the parasite. Indications for use Diseases caused by infections: - enterobiasis (Enterobius vermicularis) - ascariasis (Ascaris lumbricoides) - trichinosis (Trichuris trichiura) - hookworm disease (Ancylostoma duodenale) - necatoriasis (Necator americanus) - strongyloidiasis (Strongyloides stercoralis) - taeniasis (Taenia spp) and mixed infections. Method of administration and dosage For enterobiasis, children from 6 to 10 years old - 25-50 mg per day in one dose for 3 days. Children over 10 years of age and adults, regardless of body weight, take 100 mg of the drug (1 tablet) once. Treatment should be repeated after 2-4 weeks, due to frequent relapses of infection. Simultaneous treatment of all family members is recommended. For ascariasis, trichinosis, hookworm and mixed infections: adults, 200 mg/day for 3 days. (1 tablet morning and evening). Children from 6 to 10 years old - 25-50 mg per day in one dose for 3 days. For taeniasis, strongyloidiasis: - adults for three days, 2 tablets morning and evening (400 mg/day); - children for three days, one tablet in the morning and evening (200 mg/day). Maximum single doses - for children from 6 years to 10 years - 50 mg, for children over 10 years - 100 mg, for adults - 200 mg, daily doses for children under 10 years - 50 mg, for children over 10 years - 200 mg , for adults - 400 mg. Side effects - dizziness, headache, weakness, drowsiness, muscle incoordination Rarely - convulsions in infants - nausea, vomiting, abdominal pain, diarrhea - allergic reactions (urticaria, angioedema, angioedema) - toxic epidermal necrolysis, Stevens syndrome - Johnson, rash - neutropenia When used in high doses for a long time: - impaired liver function, hepatitis - glomerulonephritis Contraindications - hypersensitivity to any of the components of the drug - impaired liver function - hereditary intolerance to galactose, lactose, lactase deficiency, glucose malabsorption /galactose - pregnancy and lactation - children under 6 years of age Drug interactions Simultaneous administration of cimetidine with Vermox increases the concentration of the latter in plasma during long-term treatment. It is recommended to determine plasma concentrations of the drug to ensure the required doses of both drugs. The simultaneous use of mebendazole and metronidazole should be avoided. Special instructions For long-term use, monitoring of general blood count, liver and kidney function is necessary. The drug is incompatible with alcohol. During the treatment period there is no need to prescribe laxatives or follow a diet. Vermox reduces the need for insulin in patients with diabetes. In case of lactose intolerance, please note that each tablet of the drug contains 110 mg of lactose monohydrate. Peculiarities of the drug's influence on the ability to drive a vehicle and operate potentially dangerous machinery. Vermox does not affect the ability to drive a car or control working mechanisms. Overdose Symptoms: spasmodic abdominal pain, nausea, vomiting, diarrhea. Treatment: there is no specific antidote. In the first hour after an overdose - gastric lavage, taking activated charcoal. Release form and packaging 6 tablets in a blister pack made of polyvinyl chloride film and aluminum foil. 1 contour package along with instructions for medical use in the state and Russian languages ​​is placed in a cardboard box. Storage conditions Store at temperatures from 15 ºС to 30 ºС. Keep out of the reach of children! Shelf life: 5 years Do not use after expiration date. Conditions for dispensing from pharmacies By prescription Name and country of the manufacturing organization Gedeon Richter Romania A.O., Romania Name and country of the owner of the registration certificate JSC Gedeon Richter, Budapest, Hungary Name and license holder Janssen Pharmaceutica, Belgium Address of the receiving organization in the Republic Kazakhstan claims from consumers regarding product quality Representative office of JSC Gedeon Richter in the Republic of Kazakhstan E-mail Telephone: 8-(7272)-58-26-22, 8-(7272)-58-26-23

Symptoms of overdose, nuances of interaction

If the recommended amount of Vermox is accidentally exceeded, patients experience the appearance of non-standard symptoms. Patients complain:

• for discomfort in the abdominal area;
• attacks of vomiting with nausea;
• dyspeptic disorders.

High dosages with long-term use can provoke the development of hepatitis, neutropenia, and liver dysfunction. First aid consists of gastric lavage and the use of sorbents. Complex intoxications require symptomatic therapy.

The instructions indicate the possible interaction of Vermox and other agents with the subsequent occurrence of effects:

• combination with Cimetidine – increases the amount of mebentazole, reduces the volume of carbamezine in the blood;
• combination with insulin drugs requires a reduction in their dose.

The abstract advises avoiding the simultaneous use of Vermox and lipophilic drugs.

Vermox tablets 100 mg No. 6x1

Name

Vermox tablet 100 mg in bl. in pack №6x1

Description

Round, flat, pale orange tablets, scored on one side, with a beveled edge, printed "Me/100" on one side and "JANSSEN" on the other.

Main active ingredient

Mebendazole

Release form

Pills

Dosage

100 mg

Pharmacological properties

Pharmacodynamics

Mebendazole is a broad-spectrum anthelmintic that prevents the formation of cellular tubulin in helminths, thus disrupting the utilization of glucose and the digestive functions of helminths, which leads to autolysis of the parasite.

Pharmacokinetics

Absorption. After oral administration, less than 10% of the dose reaches the systemic circulation due to incomplete absorption and extensive first-pass metabolism (first-pass effect). Maximum plasma concentrations are achieved 2–4 hours after administration. Simultaneous use of the drug with high-calorie food leads to a slight increase in the bioavailability of mebendazole. Distribution. 90–95% of the drug dose is bound to plasma proteins. The volume of distribution is 1–2 l/kg, indicating that mebendazole penetrates beyond the blood vessels. This is supported by data on the presence of mebendazole in tissues in patients on long-term therapy (eg, 40 mg/kg per day for 3 to 21 months). Metabolism. After oral administration, mebendazole is metabolized primarily in the liver. Plasma concentrations of its main metabolites are significantly higher than those of mebendazole. Impaired liver function, metabolic disorders or impaired bile secretion may lead to increased plasma levels of mebendazole. Excretion. Mebendazole, conjugated forms of mebendazole and its metabolites are partially subject to enterohepatic recirculation and are excreted in urine and bile. The half-life after oral administration is 3–6 hours in most patients. Pharmacokinetics with long-term use. With long-term use (for example, 40 mg/kg per day for 3 to 21 months), the concentration of mebendazole and its main metabolites in the blood plasma increases, resulting in an approximately 3-fold increase in the effect of the drug with long-term use compared to a single dose.

Indications for use

Vermox® is indicated for the treatment of mono- or mixed infestations caused by Enterobius vermicularis (pinworms); Ascaris lumbricoides (large roundworms

roundworms

); Trichuris trichiura (whipworm); Ancylostoma duodenale (common hookworm); Necator americanus (necator); Strongyloides stercoralis; Taenia saginata and Taenia solium (tapeworms

bovine tapeworm and pork tapeworm

).

Directions for use and doses

For enterobiasis, adults and children over 2 years of age are prescribed 1 tablet (100 mg) of the drug once. To prevent re-infestation, you should repeat taking 1 tablet (100 mg) of the drug after 2 or 4 weeks. For ascariasis, trichuriasis, hookworm or their combinations, adults and children over 2 years of age are prescribed 1 tablet (100 mg) twice a day (morning and evening) for 3 days. For taeniasis and strongyloidiasis, adults are recommended to take 2 tablets (200 mg) twice a day (morning and evening) for 3 days; Children over 2 years of age are prescribed 1 tablet (100 mg) twice a day (morning and evening) for 3 days. Information on the use of the drug in children under 2 years of age is contained in the “Children” section. The tablets can be chewed or swallowed whole, regardless of the time of meal. For young children, the tablet must be crushed before use. If the next dose of the drug was missed, then you should not double the dose during the next dose.

Use during pregnancy and lactation

Since Vermox® is contraindicated during pregnancy, patients who are pregnant or who suspect pregnancy should not use the drug. It is not known whether mebendazole is excreted in breast milk, therefore breastfeeding is not recommended when using the drug Vermox®. Ability to conceive The results of studies of the effect of the drug Vermox® on reproductive function demonstrated no effect on the ability to conceive when taken in doses up to 10 mg/kg per day inclusive. Children Used to treat children over 2 years of age. Due to the lack of experience with the use of the drug in children under 2 years of age, and also because there are isolated reports of the occurrence of seizures during the use of the drug in children of this age group, Vermox® should be prescribed only if the presence of helminthic infestation is seriously noted on the their nutritional status and physical development.

Interaction with other drugs

Concomitant use with cimetidine can lead to an increase in the effect of Vermox due to inhibition of its metabolism in the liver and an increase in the concentration of mebendazole in plasma. The simultaneous use of mebendazole and metronidazole should be avoided.

Contraindications

Vermox® is contraindicated in patients with hypersensitivity to mebendazole or any of the excipients. Vermox® is contraindicated during pregnancy.

Compound

active ingredient: 1 tablet contains 100 mg of mebendazole; excipients: microcrystalline cellulose, sodium starch glycolate (type A), talc, corn starch, sodium saccharin, magnesium stearate, hydrogenated cottonseed oil, orange flavor, colloidal anhydrous silica, sodium lauryl sulfate, orange-yellow S (E 110).

Overdose

In patients who used doses higher than recommended or were treated for a long time, alopecia, reversible liver dysfunction, hepatitis, agranulocytosis, neutropenia and glomerulonephritis were rarely observed. Such adverse reactions, with the exception of agranulocytosis and glomerulonephritis, were also observed in patients who used mebendazole in standard dosage (see section "Adverse reactions"). Symptoms. In case of accidental overdose, cramping abdominal pain, nausea, vomiting and diarrhea may occur. Treatment. There is no specific antidote. If warranted, activated charcoal may be prescribed.

Side effect

By frequency, adverse reactions that were observed are classified as follows: very often (? 1/10), often (? 1/100 to

Storage conditions

Store out of the reach of children at a temperature of 15 °C to 30 °C.

Analogs

The occurrence of adverse reactions to therapeutic measures requires stopping treatment and replacing the drug. Popular analogues of Versmox are presented:

• Vormin, Vero-Mebendazole;
• Vermakar, Mebex;
• Mebendazole, Telmox 100.

The choice of a suitable substitute is the responsibility of the therapist. The doctor is based on the causes of intolerance to the drug and selects a safer analogue.

Reviews

On the forums there are positive responses from patients who have been treated with anthelmintic medications. The effectiveness of Vermox for children and adults is proven by the results obtained. Parents believe that the medicine is more effective than analogues, but due to its toxicity it is not suitable for prophylactic use.

Patients note that accurate implementation of the therapy regimen allows you to quickly get rid of painful sensations in the abdomen and normalize the functioning of the gastrointestinal tract. In rare cases, negative reviews are associated with the development of side effects during procedures.

Features of therapy for parasitic infestations in children

A parasitic disease is the development of painful symptoms as a result of the activity of a helminth or protozoa in the human body [1]. The main factor in the survival and spread of parasites is their unusually high reproductive capacity, as well as constantly improving mechanisms of adaptation to living in the human body. Unfortunately, the alertness of medical workers regarding parasitic diseases among the population is currently extremely low, and the prevention of helminthiasis is reduced to the treatment of identified infested patients [12, 13]. At the same time, many researchers note the connection between the widespread prevalence of parasitosis in the child population and the development of functional pathology of the digestive organs against the background of regulatory disorders and the high risk of developing chronic diseases even if the child is naturally rehabilitated over time.

The most common and studied diseases - ascariasis, enterobiasis (Fig. 1) and giardiasis - are registered everywhere. In Russia, more than 2 million patients with nematodes are diagnosed annually. When assessing the territorial distribution of giardiasis in Russia, it was found that the highest average level of incidence rates over many years was noted in St. Petersburg, and the incidence of children attending child care institutions was 35% [2].

Each person repeatedly experiences various parasitic diseases during his life [9]. Parasitosis is more common in childhood. In young children (under 5 years of age), this is facilitated by the widespread prevalence of reproductive material of parasites (cysts, eggs, larvae (Fig. 2)) in the environment and insufficient development of hygienic skills.

Periods of transient weakening of the immune defense of the mucous membranes of the digestive tract are also important. Peaks of detected parasitic diseases in children are observed at the ages of 2–3 years, 4–7 years, and 10–14 years. In the morbidity structure, the share of young children and schoolchildren reaches 95% among all registered patients with enterobiasis and 65% among patients with ascariasis [1].

These periods of a child’s life are characterized by intense adaptation processes and a decrease in defense reserves, along with intense environmental influences. Comparison of the significance of the criteria that determine the characteristics of the selected age segments (mass-growth “jumps”, critical periods of development of the immune system, peaks of primary morbidity) allows us, first of all, to highlight the level of metabolism that increases at this time in the child’s body, aimed at ensuring the mass-growth spurt. This condition is beneficial for parasites, since the main task of their life activity is the production of a huge amount of reproductive material (eggs, cysts), which also first of all requires a very high intensity of metabolic processes. For example, with giardiasis, up to 12 million cysts are released in 1 g of feces of a sick person [4, 8].

The importance of certain risk factors varies according to the age of the child. It has been proven that for young children, sanitary and hygienic living conditions are more important, and for adolescents, when collecting anamnesis, it is necessary to pay attention to socio-economic and geographical factors (staying in a camp, a tourist trip, the presence of a younger brother or sister) (Fig. 3).

A transient decrease in anti-infective immunity as a risk factor for the occurrence of parasitosis in children is also recorded during the period of convalescence after viral diseases caused by viruses of the herpetic group (cytomegalovirus, herpes simplex virus I and II, Epstein-Barr virus), and may arise as a result of iatrogenicity (the use of immunosuppressive therapy for allergic and autoimmune diseases). Currently, a significant proportion of children are in a state of maladaptation, which is also accompanied by a decrease in immune defense.

The immune defense of the child’s gastrointestinal tract (GIT) can be divided into specific and nonspecific. Nonspecific protection includes a set of conditions for normal digestion: the maturity of enzymatic systems, the provision of an acid-base gradient in various parts of the gastrointestinal tract, the activity of normal microflora, and adequate motility.

In some cases, nonspecific protection may be impaired. For example, the maturity of enzyme systems depends on the biological age of the child, which does not always coincide with the passport age. Often this so-called phenomenon of delayed enzymatic start is included in the phenotype of a child with diffuse connective tissue dysplasia. This phenotype may also include the following specific signs: anomalies in the development of the auricle, a “Gothic” palate, epicanthus, hypertelorism, joint hypermobility syndrome, minor anomalies in the development of the heart, gallbladder, etc. The existing functional deficiency of enzyme systems in such a child is combined with changes in elasticity and the strength of the gastrointestinal tract wall, creating a predisposition to the occurrence of functional disorders of the digestive organs. Studies have proven that in children with more than 5 of the above minor developmental anomalies, parasitic infestations are observed in 78% of cases, while in the control group the incidence of parasitosis was less than 45% [3, 6].

Separately, it should be noted that for a disease such as giardiasis, a predisposing factor for invasion is the irregular and insufficient secretion of bile into the intestines due to abnormalities in the development of the gallbladder (constrictions, kinks). Giardiasis identified in patients of the pediatric department of MONIKI was accompanied by biliary tract dysfunction in 100% of cases.

In children in the recovery period after acute intestinal infections, after massive antibiotic therapy, as well as in patients with chronic pathology of the digestive organs, concomitant disturbances in enzyme support, normal flora and intestinal motility also make the gastrointestinal tract more vulnerable to parasites (Fig. 4).

Specific protection of the mucous membrane of the digestive organs depends on the child’s age and maturity. The mechanism of specific immune defense is one of the most ancient systems of the body, since helminthiases have accompanied humanity for many millennia. This mechanism is represented primarily by blood eosinophils and immunoglobulin E.

The classic extensive antiparasitic response can be formed in a child no earlier than 4 years of age and is closely related to the quality and quantity of IgE that matures by this age. When the body comes into contact with the parasite, inflammatory mediators are primarily released: interleukin, leukotriene C4, D4, prostaglandins, thromboxanes. The number of lymphocytes producing IgM and IgG increases. In a clinical blood test, an increase in the level of eosinophils and basophils is noted, associated with an increase in the content of these cells in the tissues of the invaded organ. When meeting parasite larvae, tissue basophils secrete heparin and histamine, which, in combination with leukotrienes and other inflammatory mediators, cause general symptoms: itching, reactive edema, hyperemia, and can also provoke general symptoms: bronchospasm, manifestations of urticaria or diarrhea. Allergic inflammation during parasitosis develops along the classical path and is intended to create conditions leading to the death and/or elimination of the parasite [5].

At the same time, eosinophils have a pronounced cytotoxic potential that exceeds the capabilities of other blood cells, which explains the primary importance of eosinophils in antiparasitic reactions and their damaging role in allergies. Eosinophils have their main effect in barrier tissues. At the site of invasion, they degranulate, exerting helminth-toxic and cytotoxic effects. Eosinophil granule proteins (large basic protein, eosinophil peroxidase, eosinophil cationic protein, eosinophil-derived neurotoxin) are toxic not only to the parasite, but also to the cells of the child's body. Another important cause of systemic and organ damage accompanying parasitosis is the formation of immune complexes [9, 10].

The effect of parasites on a child’s body involves many systems. Almost all of their types can cause a shift in the Th1/Th2 cell ratio in a direction favorable for their survival. Cases have been described in which parasite excretion products had a hormone-like effect on the host organism [5].

Parasites exert their local influence by causing contact inflammation of the mucous membrane and stimulating autonomic reactions. In this case, the processes of intestinal absorption, adequate motility of the gastrointestinal tract and its microbiocenosis are disrupted.

The systemic effect is due to the parasite’s use of the energy and plastic potential of food to the detriment of the child’s body, induction of allergies and autoimmune processes, targeted immunosuppression and endogenous intoxication. Studies have shown that allergic syndrome accompanies ascariasis and enterobiasis in 71.3% of cases. Among children with atopic dermatitis, parasitosis is detected in 69.1%, with giardiasis accounting for 78.5% of all invasions [4].

A particularly recognizable clinical picture is formed by toxocariasis (Fig. 5). Clinical markers of this invasion are the leukemoid reaction of eosinophils (20% or more eosinophils in the blood count), accompanying a pronounced and persistent allergic syndrome in the form of atopic dermatitis with severe itching and resistance to traditional therapy or severe bronchial asthma with frequent attacks.

In 75.3% of cases, parasitosis is accompanied by various functional disorders of the gastrointestinal tract. A number of studies have proven that parasitic invasion can cause disturbances in carbohydrate metabolism, as well as disaccharidase deficiency due to a decrease in lactase levels [7, 9].

Parasitic infestations, as a rule, are accompanied by neurotic reactions of varying degrees of severity, in particular, Giardia is not without reason called “parasites of melancholy and sadness.”

In most children, adaptation disorders are one of the important links in the pathogenetic process of parasitosis. It should be noted that the state of maladaptation primarily affects the lymphocytic link of immunogenesis, which cannot but affect the maturation and differentiation of specific immunity.

Diagnosis of parasitosis

Until now, the search for a simple, accessible and reliable method for diagnosing parasitosis is ongoing. The developed methods of direct visual detection require minimal exposure to diagnostic material and multiple repeated studies. Known methods for diagnosing helminthic infestations and protozoa, such as the Kato thick fecal smear method, the formalin-ether deposition method, perianal scraping, microscopy of bladder and hepatic bile, have a number of disadvantages associated both with the developmental characteristics of the parasite and with the state of the macroorganism and its reactivity.

However, the effort expended may be useless if the study is carried out during a pause in the production of cysts or eggs. For example, the uninformativeness of perianal scraping with a 1–2-fold examination method is due to the frequency of oviposition by female pinworms. The peculiarity of the excretion of cysts by Giardia is called the “phenomenon of intermittent cyst excretion,” in which the phases of massive cyst excretion are replaced by a negative phase, which can last from 2–3 days to 2–3 weeks. During this period, it is impossible to detect Giardia in feces.

Indirect research methods (determination of specific antibodies) lack specificity and reliability. It is known, for example, that, going through a complex development cycle from egg to adulthood, helminths change their antigenic composition. Antibodies in the host's body are produced mainly in response to the intake of helminth excreta and secretions, while somatic antibodies are used in immunodiagnostic reactions. The emerging nonspecific sensitization of the body, the commonality of some antigens of trematodes, protozoa and humans create a high proportion of false-positive serological reactions in titers below the reliably diagnostic ones. Thus, testing by enzyme immunoassay (ELISA) for helminths is a highly sensitive but low specific method. Determination of parasites using the polymerase chain reaction (PCR) method is a highly specific and highly sensitive method, but due to its high cost and complexity it cannot be used for screening when, for example, it is necessary to examine a group of children from a children's institution.

The clinical examination of the child and careful consideration of indirect signs of parasitosis do not lose their relevance. It is important to note the possibility of parasitosis in allergic and asthenic syndrome, polylymphadenopathy of unknown origin, impaired intestinal absorption, carbohydrate metabolism, protracted and chronic course of diseases of the digestive tract, hepatosplenomegaly of unknown origin. The course of parasitic infestation has clinical features: usually the signs of damage are minimized, the disease is of a muted nature, exacerbations are polymorphic and dim. A feature of exacerbations of diseases in this group is their cyclical nature with a period of 11–15 days.

Indirect laboratory signs of parasitosis can be anemia, basophilia, eosinophilia, and an increase in the level of aspartate aminotransferase (AST).

In addition, signs of possible parasitic invasion should be taken into account when assessing the results of instrumental research. During an ultrasound examination of the abdominal organs in a child over 3 years of age, indirect signs of parasitosis are hepatosplenomegaly, unevenness of the liver and spleen parenchyma due to small hyperechoic signals, and enlarged lymph nodes in the hilum of the spleen.

Parasitic infestation determines the appearance and complaints of the child. Usually this is an emotionally labile and anxious child with dry pale skin, with signs of impaired regeneration of the skin and mucous membranes, with polylymphadenopathy, adenoid vegetations of the II-III degree, “jams” in the corners of the mouth, a “geographical” tongue, with a reduced or selective appetite, often with unstable stool. Various manifestations of allergic syndrome are also noted in the form of recurrent urticaria, persistent atopic dermatitis or broncho-obstructive syndrome.

Treatment of helminthiasis

Treatment of helminthiases should begin with the use of specific anthelmintic drugs. The modern arsenal of drugs used to treat intestinal parasitosis includes a significant number of drugs of various chemical classes [11]. They are used both in clinical practice for the treatment of identified patients, and for the purpose of mass prevention.

When determining a drug for specific antiparasitic therapy, it should be understood that the spectrum of action of these drugs is not particularly wide. Almost all drugs in this group have been used for many decades and it is reasonable to assume that the parasites have developed adaptation systems and the disease may be resistant to the therapy. According to G.V. Kadochnikova (2004), the effectiveness of such a traditional drug as Dekaris in modern conditions does not reach 57%. In addition, this group of antiparasitic drugs, unfortunately, has a number of side effects: nausea, vomiting, abdominal syndrome.

Thus, in modern conditions, preference should be given to more modern drugs, which, firstly, are universal for the treatment of both nematodes and mixed helminthic infestations and are active against such a common parasite as Giardia. Secondly, using one antiparasitic drug, rather than a combination of them, significantly reduces the risk of unpleasant side effects. Today, the only representative of this group in our country is albendazole (Nemozol).

To treat ascariasis in older children or when the disease recurs, a combination of anthelmintic drugs (for example, albendazole for three days, then Vermox for three days) can be used under medical supervision. An indispensable condition for successful deworming of patients with enterobiasis is the simultaneous treatment of all family members (team) and strict adherence to a hygienic regime to prevent reinfestation. It should be noted that daily wet cleaning is important, since occasional cases of pinworm reproductive material spreading on dust particles to a height of 1.5 meters have been described.

Treatment of giardiasis involves a mandatory diet with limited consumption of easily digestible carbohydrates, increasing the proportion of protein in food, consumption of “acidifying” products (decoctions of lingonberries, cranberries), and the use of choleretic decoctions and drugs.

In the pediatric clinic of MONIKI, principles of parasitosis therapy have been developed that take into account the characteristics of the pathogenesis of invasion and allow high-quality and reliable treatment of this group of diseases. Thanks to the use of the developed treatment regimen, it is possible to effectively prevent reinvasion and the development of functional disorders of the digestive organs in children.

Principles of therapy for patients with parasitosis

1. Taking antiparasitic drugs is carried out taking into account the type of causative agent of the invasion.

Drugs used in the treatment of ascariasis:

• Vermox (mebendazole) (for children over 2 years old) - 100 mg 2 times a day for 3 days;
• Pyrantel - 10 mg/kg once;
• Nemozol (albendazole) (for children over 2 years old) - 400 mg once.

Drugs used in the treatment of enterobiasis:

• Vermox (mebendazole) (for children over 2 years old) - 100 mg once;
• Pyrantel - 10 mg/kg once;
• Nemozol (albendazole) (for children over 2 years old) - 400 mg once.

Drugs used in the treatment of giardiasis:

• ornidazole 25–30 mg/kg (if body weight is more than 35 kg - 1000 mg) in two doses for 5 days, 1 day - 1/2 dose, repeat course after 7 days;
• Macmiror (nifuratel) - 15 mg/kg 2 times a day for 7 days;
• Nemozole (albendazole) - 15 mg/kg once for 5-7 days.

2. Treatment of parasitosis involves changes in the properties of the child’s digestive tract as a result of the vital activity of parasites (functional disorders of the digestive organs, fermentopathy, changes in microbiocenosis) and their correction with courses of enzyme preparations and synbiotics (Table 1).

3. Mandatory use of enterosorbents and a complex of multivitamins with microelements (Tables 2 and 3).

Thus, the principles of complex therapy of parasitosis in children, developed at the MONIKI pediatric clinic, provide for the gradual restoration of the functional state of the gastrointestinal tract, disturbed as a result of the local and systemic influence of parasites. The use of complex therapy makes it possible to prevent further development of functional disorders with the formation of organic pathology, as well as to avoid reinvasion.

Literature

1. Avdyukhina T.I., Konstantinova T.N. et al. Enterobiasis. Clinic, diagnosis, treatment, epidemiology, prevention: Textbook. manual for doctors. M., 2003. 56 p.
2. Blagova N.N. Some immunity factors in patients with ascariasis and enterobiasis during treatment with albendazole: Abstract of thesis. dis. ...cand. honey. Sci. St. Petersburg, 1997. 24 p.
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L. I. Vasechkina1, Candidate of Medical Sciences T. K. Tyurina, Candidate of Medical Sciences L. P. Pelepets, Candidate of Biological Sciences A. V. Akinfiev, Candidate of Medical Sciences

GBUZ MO MONIKI named after. M. F. Vladimirsky, Moscow

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