Case Report: Ivermectin and Albendazole Plasma Concentrations in a Patient with Disseminated Strongyloidiasis on Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy

Carl Boodman

Yashpal Chhonker

Daryl Murry

Allison Mah

^{Department of Medicine, University of British Columbia, Vancouver, Canada;}

^{University of Nebraska Medical Centre, Omaha, Nebraska;}

^{Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada;}

^{J. D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada;}

^{Department of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada}

^{Address correspondence to Carl Boodman, Department of Medicine, University of British Columbia, Laurel Street, 10th Floor, Vancouver, BC Canada V5Z 1M9. E-mail:}ac.cbu.inmula@namdoob.lrac

Authors’ addresses: Carl Boodman, Department of Medicine, University of British Columbia, Vancouver, Canada, E-mails: ac.cbu.inmula@namdoob.lrac or ac.lligcm.liam@namdoob.lrac. Yashpal S. Chhonker and Daryl J. Murry, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, E-mails: ude.cmnu@reknohhc.y and ude.cmnu@yrrum.jd. Allison Mah, Jennifer Grant, and Theodore Steiner, Division of Infectious Diseases, University of British Columbia, Vancouver, Canada, E-mails: ac.cbu.liam@hamilla, ac.hcv@tnarG.refinneJ, and ac.cbu.liam@renietst. Michael Libman, J. D. MacLean Centre for Tropical Medicine, McGill University, Montreal, Canada, E-mail: ac.lligcm@nambil.leahcim. Cesilia Nishi, Department of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada, E-mail: ac.hcv@ihsin.ailisec. Marthe Charles, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada, E-mail: ac.hcv@selrahc.ehtram.

Received 2018 Jun 9; Accepted 2018 Aug 19.

Abstract.

Disseminated strongyloidiasis is often fatal, despite treatment with oral albendazole and parenteral ivermectin (IVM). Here, we report elevated plasma IVM and albendazole sulfoxide concentrations in the context of extracorporeal membrane oxygenation and continuous renal replacement therapy in a patient with disseminated strongyloidiasis treated with subcutaneous IVM and nasogastric albenzadole. Despite elevated drug plasma concentrations, live filariform larvae were detected in endotracheal aspirates after 2 weeks of treatment.

Abstract.

ABZ = albendazole; IVM = ivermectin.

IVERMECTIN Concentrations.

For IVM, plasma concentrations were determined using HPLC with fluorescence detection as previously described.¹ Albendazole, ABZ-OX, and ABZ-ON were determined using a validated liquid chromatography–mass spectrometric (LC-MS/MS) method.²

ABZ = albendazole; IVM = ivermectin.

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