Strongyloidiasis disease is a serious parasitic infection caused by the threadworm Strongyloides stercoralis, a tiny nematode capable of creating long-term infections in the human body. While relatively rare in the United Kingdom, this condition presents significant health risks for adults who have traveled to or lived in tropical and subtropical regions where the parasite is widespread. Because the infection can remain silent for decades, early awareness and proper medical care are crucial for those at risk.

What makes strongyloidiasis particularly complex is its ability to complete its full life cycle within a single host. Through a process known as autoinfection, the parasite can reproduce internally without external exposure, allowing the infection to persist and progress. This feature makes timely diagnosis and treatment essential, especially in individuals preparing for immunosuppressive therapy. Among the leading treatment options, ivermectin 3 mg has proven highly effective, offering reliable outcomes for adults diagnosed with this parasitic condition.

This comprehensive guide explores the best treatment options for strongyloidiasis in adults, with a strong focus on evidence-based therapies approved for use in the UK healthcare system. It will outline how the disease develops, highlight the most common strongyloidiasis symptoms, and detail treatment protocols that follow MHRA-approved standards. Special attention will be given to the role of ivermectin 3 mg in improving recovery and ensuring long-term protection.

Understanding Strongyloidiasis Disease

Strongyloidiasis occurs when individuals come into contact with soil contaminated by Strongyloides stercoralis larvae. The infection typically begins when these microscopic larvae penetrate intact skin, usually through the feet of people walking barefoot on contaminated ground. Once inside the body, the parasites migrate through various tissues before establishing residence primarily in the small intestine.

The Strongyloides stercoralis life cycle comprises both free-living and parasitic phases, which contributes to the complexity of infection patterns. After skin penetration, larvae travel through the bloodstream to the lungs, where they are coughed up and subsequently swallowed, eventually maturing into adult worms in the small intestine. Female worms embed themselves in the intestinal mucosa, producing eggs that hatch into larvae. Some of these larvae are excreted in faeces, whilst others can transform into infective forms whilst still within the intestine or perianal area, leading to autoinfection.

This autoinfection capability distinguishes Strongyloides stercoralis from most other intestinal parasites and explains why infections can persist for thirty years or more without re-exposure. The cycle of autoinfection becomes particularly dangerous in immunocompromised individuals, where it can escalate into hyperinfection syndrome or disseminated strongyloidiasis, conditions associated with high mortality rates if left untreated.

Recognising Strongyloidiasis Symptoms in Adults

The clinical presentation of strongyloidiasis varies considerably amongst adults, ranging from completely asymptomatic cases to severe, life-threatening manifestations. Many individuals harbour chronic infections without experiencing noticeable symptoms, which underscores the importance of screening high-risk populations before initiating immunosuppressive treatments.

When strongyloidiasis symptoms do manifest, they typically affect multiple organ systems. Gastrointestinal symptoms represent the most common presentation, including intermittent abdominal pain, bloating, alternating diarrhoea and constipation, and occasionally nausea. Some patients experience a distinctive migratory rash known as larva currens, which appears as a rapidly moving, serpiginous urticarial track on the skin, particularly around the buttocks, thighs, and lower abdomen. This rash results from subcutaneous larval migration and can recur episodically over years.

Respiratory symptoms may occur during the pulmonary migration phase, presenting as a dry cough, wheezing, or transient pulmonary infiltrates resembling asthma or pneumonia. These manifestations, combined with peripheral eosinophilia detected in blood tests, often provide the first clinical clues suggesting parasitic infection. Additionally, some adults report chronic fatigue, unexplained weight loss, and intermittent urticaria, symptoms that can easily be attributed to other conditions, delaying accurate diagnosis.

Strongyloides Stercoralis Symptoms: When to Seek Medical Attention

Whilst chronic strongyloidiasis often produces mild or intermittent symptoms, certain presentations warrant immediate medical evaluation. Adults should seek prompt medical attention if they experience persistent diarrhoea lasting more than two weeks, particularly if accompanied by abdominal pain and unexplained weight loss. The appearance of larva currens—the characteristic creeping eruption on the skin—should prompt immediate investigation for strongyloide stercoralis infection, as this symptom is highly specific to this parasitic disease.

Individuals with compromised immune systems face the greatest risk of developing severe complications. Those taking corticosteroids, undergoing chemotherapy, living with HIV/AIDS, or receiving immunosuppressive therapy for organ transplantation or autoimmune conditions must remain particularly vigilant. In immunocompromised states, the relatively benign chronic infection can rapidly progress to hyperinfection syndrome, characterised by massive larval multiplication and widespread organ dissemination.

Signs of hyperinfection strongyloides include severe, persistent diarrhoea often containing blood, diffuse abdominal pain, respiratory distress with productive cough, and sepsis-like symptoms including fever and hypotension. Skin hyperinfection strongyloides may present as purpuric lesions or petechiae, particularly around the abdomen and thighs, resulting from larval migration through subcutaneous tissues. These severe manifestations constitute medical emergencies requiring immediate hospitalisation and aggressive treatment, as mortality rates can exceed fifty percent without prompt intervention.

Primary Treatment: Ivermectin for Strongyloidiasis

Ivermectin represents the gold standard treatment for strongyloidiasis in adults and has received widespread recognition from international health authorities, including the MHRA, for its efficacy and safety profile. This antiparasitic medication works by paralysing and killing the parasites through interference with their nerve and muscle function, specifically targeting glutamate-gated chloride channels found in invertebrate nerve and muscle cells.

For uncomplicated strongyloidiasis, the standard treatment protocol involves ivermectin tablets administered at a dose of 200 micrograms per kilogram of body weight, typically taken as a single dose. However, many specialists recommend a two-day course, with doses given twenty-four hours apart, to ensure complete eradication of all larval stages. This extended regimen accounts for the complex life cycle of Strongyloides stercoralis and helps prevent treatment failure due to larvae that may not be susceptible during a single-dose administration.

The medication demonstrates excellent oral bioavailability and tissue penetration, allowing it to reach parasites throughout their migration pathways. Clinical studies have consistently shown cure rates exceeding ninety percent with ivermectin treatment, significantly outperforming alternative therapies. Most adults tolerate ivermectin tablets well, with side effects generally mild and transient, including mild gastrointestinal disturbance, dizziness, or headache. These effects typically resolve within twenty-four to forty-eight hours and rarely necessitate treatment discontinuation.

Iverheal 6 MG: Formulation and Administration

Iverheal 6 MG represents a specific formulation of ivermectin designed for convenient oral administration in the treatment of parasitic infections including strongyloidiasis. Each tablet contains six milligrams of ivermectin, allowing for straightforward dosing calculations based on patient body weight. For an adult weighing approximately seventy kilograms, the typical treatment regimen would involve taking two Iverheal 6 MG tablets to achieve the recommended dose of 200 micrograms per kilogram.

Administration of Iverheal 6 MG should occur on an empty stomach, ideally at least one hour before or two hours after meals, accompanied by a full glass of water. Taking the medication without food enhances absorption and maximises therapeutic efficacy. Patients should avoid consuming alcohol during treatment and for at least twenty-four hours following the final dose, as alcohol may potentially increase the risk of side effects or reduce medication effectiveness.

For chronic strongyloidiasis without hyperinfection, physicians typically prescribe Iverheal 6 MG for two consecutive days, repeating the course after two weeks to ensure complete parasite eradication. This staggered approach accounts for larvae at different developmental stages and minimises the risk of persistent infection. Follow-up stool examinations and serological testing should be conducted three to six months post-treatment to confirm cure, as recommended by MHRA-approved treatment guidelines for parasitic infections in the UK.

Alternative Treatment Options for Strongyloides

Whilst ivermectin remains the preferred treatment for strongyloidiasis, alternative medications may be considered in specific circumstances where ivermectin is contraindicated, unavailable, or has failed to achieve cure. Albendazole, another broad-spectrum antiparasitic medication, represents the primary alternative, though it demonstrates lower efficacy compared to ivermectin, with cure rates generally ranging between forty-five and seventy-five percent.

Treatment strongyloides with albendazole typically requires a longer duration, usually seven to ten days at a dose of 400 milligrams twice daily. This extended course attempts to compensate for the drug's relatively lower effectiveness against all parasite stages. Some clinicians employ combination therapy, using both ivermectin and albendazole concurrently, particularly in cases of hyperinfection syndrome where aggressive treatment is essential. However, evidence supporting this approach remains limited, and it should only be undertaken under specialist supervision.

Thiabendazole, historically the first effective treatment for strongyloidiasis, has largely fallen out of favour due to its significant side effect profile, including severe gastrointestinal disturbances, neurological symptoms, and liver toxicity. Nevertheless, it may occasionally be considered when other options have failed or are unavailable. The decision to pursue alternative treatments should always involve consultation with infectious disease specialists or tropical medicine experts familiar with the complexities of parasitic infections and equipped to manage potential complications.

Managing Hyperinfection Syndrome and Disseminated Disease

Hyperinfection strongyloides and disseminated strongyloidiasis represent severe, potentially fatal complications requiring immediate intensive care intervention. These conditions occur almost exclusively in immunocompromised adults and result from uncontrolled larval multiplication and widespread organ infiltration. Management of these severe forms differs substantially from treatment protocols for uncomplicated infection.

In hyperinfection syndrome, ivermectin dosing must be more aggressive and prolonged, typically continuing daily until clinical improvement is evident and parasitological clearance is confirmed. Treatment may need to continue for weeks rather than days, with doses administered either orally or, in critically ill patients unable to take oral medications, via subcutaneous or rectal routes, as intravenous formulations are not routinely available. Concurrent management of secondary bacterial infections is essential, as gut-derived bacteria can disseminate systemically alongside migrating larvae, causing life-threatening sepsis.

The skin hyperinfection strongyloides manifestation requires particular attention, as cutaneous findings may indicate widespread larval dissemination. Purpuric lesions, petechiae, and extensive urticarial rashes warrant immediate dermatological assessment alongside systemic treatment. If possible, immunosuppressive medications should be reduced or temporarily discontinued under careful medical supervision, though this decision must balance the risks of the underlying condition requiring immunosuppression against the immediate threat posed by uncontrolled parasitic infection. Multidisciplinary care involving infectious disease specialists, intensivists, and relevant specialists managing the patient's underlying conditions is essential for optimal outcomes.

Important Precautions Before Starting Treatment

Prior to commencing treatment for strongyloidiasis, several important considerations must be addressed to ensure safe and effective therapy. A thorough medical history should document all current medications, as certain drug interactions may affect ivermectin efficacy or increase the risk of adverse effects. Patients taking medications that affect liver enzymes, particularly those metabolised by the cytochrome P450 system, may require dose adjustments or enhanced monitoring.

Adults with pre-existing liver or kidney disease require careful assessment before beginning ivermectin therapy. Whilst the medication is generally well-tolerated, significant hepatic impairment may affect drug metabolism and clearance, potentially necessitating dose modifications. Similarly, severe renal dysfunction may warrant dosing adjustments, though ivermectin is primarily metabolised hepatically rather than renally. Baseline liver function tests and renal function assessments provide valuable information for safe treatment planning.

Women of childbearing potential should discuss pregnancy status and contraception with their healthcare provider before starting treatment. Whilst animal studies have not demonstrated teratogenic effects, ivermectin is classified as pregnancy category C, meaning adequate human data are lacking. Treatment during pregnancy should only proceed when the benefits clearly outweigh potential risks, typically reserved for severe infections threatening maternal health. Breastfeeding mothers should consult their healthcare provider, as ivermectin is excreted in breast milk in small quantities, though generally considered compatible with breastfeeding for most parasitic indications.

Monitoring and Follow-Up After Treatment

Successful treatment strongyloides requires comprehensive follow-up to confirm parasite eradication and identify any treatment failures necessitating additional therapy. The first follow-up assessment typically occurs two to four weeks post-treatment, though symptomatic improvement often begins within days. However, the absence of symptoms does not guarantee cure, as many individuals with chronic strongyloidiasis were asymptomatic before treatment.

Parasitological assessment forms the cornerstone of follow-up monitoring. Multiple stool examinations using specialised techniques, such as the agar plate culture method or Baermann concentration, should be performed at intervals of three, six, and twelve months post-treatment. These sensitive methods detect larvae more effectively than standard stool microscopy. However, even these enhanced techniques may miss low-level persistent infections, particularly in the early post-treatment period when parasite burden is reduced but not eliminated.

Serological testing provides additional monitoring value, though interpretation requires careful consideration. Antibody levels typically decline gradually following successful treatment, but may remain detectable for months or even years after parasite eradication. A significant reduction in antibody titres suggests successful treatment, whilst persistently high or rising titres may indicate treatment failure or reinfection. Eosinophil counts, often elevated in chronic strongyloidiasis, should normalise within weeks to months of successful treatment. Persistent eosinophilia warrants further investigation for residual infection or alternative diagnoses.

Preventive Measures and Risk Reduction

Preventing strongyloidiasis primarily involves avoiding contact with contaminated soil in endemic regions, though this proves challenging for individuals living in or travelling to tropical and subtropical areas. Adults visiting countries where Strongyloides stercoralis is prevalent should wear appropriate footwear at all times, avoiding walking barefoot on soil, particularly in areas where sanitation infrastructure is limited. Beach sand, whilst generally considered lower risk, can also harbour infective larvae in endemic regions.

For individuals with known past exposure to endemic areas, particularly those who lived in such regions during childhood or early adulthood, screening before initiating immunosuppressive therapy is crucial. This preventive strategy, termed presumptive treatment or screening and treatment, can prevent the catastrophic consequences of hyperinfection syndrome. UK clinical guidelines increasingly recommend serological screening for strongyloidiasis in immigrants and refugees from endemic countries before starting corticosteroids or other immunosuppressive medications.

Healthcare professionals should maintain awareness of strongyloidiasis risk factors when evaluating patients for immunosuppressive therapy. A detailed travel and residential history should form part of routine assessment, with particular attention to countries in Southeast Asia, sub-Saharan Africa, Latin America, and parts of Southern Europe where the parasite remains endemic. Presumptive treatment with ivermectin may be appropriate for high-risk individuals even in the absence of positive diagnostic tests, given the limitations of current diagnostic methods and the potentially severe consequences of undetected infection.

MHRA Approval and Regulatory Status in the UK

Within the United Kingdom, ivermectin-containing products for the treatment of parasitic infections, including strongyloidiasis, are subject to regulation by the Medicines and Healthcare products Regulatory Agency (MHRA). The MHRA has evaluated ivermectin's safety and efficacy profile, approving its use for specific parasitic indications when prescribed by qualified healthcare professionals. This regulatory approval ensures that ivermectin products available in the UK meet stringent quality, safety, and efficacy standards.

MHRA-approved ivermectin formulations are available through prescription from general practitioners, infectious disease specialists, or tropical medicine consultants. Patients should only obtain ivermectin tablets through legitimate NHS or private prescription channels, avoiding unregulated online sources that may supply counterfeit or substandard products. Authentic Iverheal 6 MG and other ivermectin formulations dispensed through UK pharmacies undergo quality assurance processes ensuring proper storage, handling, and authenticity.

The MHRA continues to monitor post-marketing safety data for ivermectin, ensuring ongoing assessment of any adverse events or emerging safety concerns. Healthcare professionals and patients are encouraged to report any suspected adverse reactions through the Yellow Card Scheme, contributing to the ongoing safety surveillance of this important antiparasitic medication. This regulatory framework provides assurance that ivermectin therapy for strongyloidiasis in the UK is both evidence-based and subject to appropriate oversight.

Drug Interactions and Contraindications

Whilst ivermectin demonstrates a favourable safety profile, certain drug interactions and contraindications warrant consideration before initiating treatment. Medications that significantly inhibit cytochrome P450 enzymes, particularly CYP3A4, may increase ivermectin blood levels, potentially enhancing both therapeutic effects and risk of adverse reactions. Common CYP3A4 inhibitors include certain antibiotics such as erythromycin and clarithromycin, antifungal agents like ketoconazole and itraconazole, and some antiretroviral medications.

Conversely, drugs that induce CYP3A4 enzymes may reduce ivermectin concentrations, potentially compromising treatment efficacy. Medications in this category include rifampicin, phenytoin, carbamazepine, and St John's Wort. Patients taking these medications may require adjusted dosing regimens or enhanced monitoring to ensure adequate therapeutic response. The concomitant use of ivermectin with warfarin requires careful monitoring of INR values, as case reports have suggested potential enhancement of anticoagulant effects.

Absolute contraindications to ivermectin are limited but important. The medication should not be administered to individuals with known hypersensitivity to ivermectin or any excipients in the formulation. Caution is warranted in patients with severe hepatic disease, as reduced metabolism may lead to drug accumulation. Additionally, whilst ivermectin effectively treats strongyloidiasis, patients with concurrent Loa loa infection (another parasitic disease found in parts of Africa) require special consideration, as ivermectin treatment in this context can precipitate serious encephalopathy due to dying microfilariae in the central nervous system.

Side Effects and Adverse Reactions

Most adults tolerate ivermectin therapy for strongyloidiasis exceptionally well, with serious adverse events occurring rarely. Common side effects, affecting approximately one to ten percent of patients, typically manifest as mild gastrointestinal disturbances including nausea, diarrhoea, or abdominal discomfort. These symptoms usually resolve spontaneously within twenty-four to forty-eight hours without requiring specific intervention. Some patients report mild dizziness, headache, or fatigue during or shortly after treatment.

Dermatological reactions occur occasionally, presenting as pruritus, urticaria, or rash. These skin manifestations may paradoxically result from the inflammatory response to dying parasites rather than direct drug toxicity, a phenomenon termed the Mazzotti reaction. When this occurs, symptoms can be managed with antihistamines or, in more severe cases, short courses of corticosteroids, though the latter must be carefully considered in the context of treating a parasitic infection that can worsen with immunosuppression.

Serious adverse events are uncommon but require recognition. Rarely, patients may experience orthostatic hypotension, tachycardia, or more significant cardiovascular effects. Neurological symptoms including tremor, vertigo, or confusion occur infrequently and typically resolve completely after drug clearance. Severe allergic reactions, whilst extremely rare, constitute medical emergencies requiring immediate treatment. Any patient experiencing difficulty breathing, facial swelling, or signs of anaphylaxis should seek emergency medical attention immediately. Laboratory abnormalities may include transient elevation of liver enzymes or changes in blood cell counts, usually resolving without intervention.

Special Considerations for Immunocompromised Adults

Adults with compromised immune systems require specialised management when diagnosed with strongyloidiasis, as this population faces substantially elevated risks of severe complications. The relationship between immunosuppression and strongyloidiasis creates a potentially lethal scenario where the infection that may have remained dormant for decades suddenly proliferates uncontrollably. Therefore, heightened vigilance and modified treatment approaches are essential for this vulnerable group.

Screening protocols for immunocompromised adults or those scheduled to begin immunosuppressive therapy should include detailed assessment for strongyloidiasis risk factors, including residence in or travel to endemic areas at any point in life. Serological testing, despite its limitations, represents the most practical screening tool, with positive results warranting treatment regardless of symptom status. Some experts advocate for presumptive treatment with ivermectin in high-risk individuals even when serological tests return negative, given the potentially catastrophic consequences of missed infection and the generally excellent safety profile of ivermectin.

Treatment duration in immunocompromised patients often extends beyond the standard two-day course. Many specialists recommend initial treatment with ivermectin on days one and two, followed by repeated courses at two-week intervals, continuing until parasitological cure is confirmed through multiple negative stool examinations and declining serological titres. For patients already receiving immunosuppressive therapy who are diagnosed with strongyloidiasis, consideration should be given to temporarily reducing or modifying immunosuppression if clinically feasible, balancing the risks of the underlying condition against the immediate threat of parasitic hyperinfection.

The Role of Diagnostic Testing

Accurate diagnosis of strongyloidiasis presents considerable challenges, as conventional stool microscopy demonstrates poor sensitivity, detecting larvae in fewer than thirty percent of infected individuals. This low sensitivity stems from the relatively small number of larvae excreted in faeces during chronic infection and their intermittent shedding pattern. Consequently, negative stool examinations cannot reliably exclude strongyloidiasis, necessitating alternative or complementary diagnostic approaches.

Enhanced parasitological methods significantly improve detection rates. The agar plate culture method, considered the gold standard for stool-based diagnosis, involves placing fresh stool on nutrient agar plates and incubating them, allowing larvae to develop into adult worms whose distinctive tracks can be visualised. This technique increases sensitivity to approximately ninety percent when multiple samples are examined. The Baermann concentration method, which exploits larvae's tendency to migrate toward warmth, represents another sensitive option, particularly when multiple stool samples are processed.

Serological testing using enzyme-linked immunosorbent assay (ELISA) to detect antibodies against Strongyloides antigens offers higher sensitivity than stool examinations, typically exceeding eighty-five percent. However, serology cannot distinguish between current and past infection, as antibodies may persist for years after successful treatment or spontaneous parasite clearance. Cross-reactivity with other helminth infections can produce false-positive results, though this issue is less problematic in the UK where most helminth infections are uncommon. Despite these limitations, serological testing serves as an invaluable screening tool, particularly for immunocompromised patients or those about to begin immunosuppressive therapy.

Travel Medicine and Strongyloidiasis Awareness

UK residents who travel to tropical and subtropical regions should receive appropriate pre-travel counselling regarding parasitic infection risks, including strongyloidiasis. Travel medicine practitioners play a crucial role in educating travellers about protective measures and helping identify those requiring post-travel screening. Whilst strongyloidiasis does not receive the same attention as malaria or travellers' diarrhoea, its potential for causing severe disease decades after exposure makes awareness essential.

Travellers visiting rural areas in endemic countries face higher infection risk, particularly those engaging in activities involving direct contact with soil, such as agricultural work, trekking, or volunteering in development projects. Adventure travellers participating in activities like jungle trekking or cave exploration may encounter contaminated soil in endemic regions. Even beach tourism in certain tropical destinations can pose risk, as coastal sand may harbour infective larvae, particularly near areas with poor sanitation infrastructure.

Post-travel screening recommendations vary based on exposure duration and intensity. Short-term tourists visiting urban areas in endemic countries generally face minimal risk and do not require routine screening. However, individuals who spent extended periods in rural endemic areas, particularly those who resided there during childhood, should discuss screening with their healthcare provider, especially before contemplating pregnancy, chemotherapy, or other immunosuppressive treatments. Serological testing several months after return allows time for antibodies to develop following any potential exposure during travel.

Cost-Effectiveness of Treatment

From a healthcare economics perspective, treatment of strongyloidiasis with ivermectin represents an exceptionally cost-effective intervention, particularly when compared to the substantial costs associated with managing hyperinfection syndrome or disseminated disease. The medication itself is relatively inexpensive, with complete treatment courses costing modest amounts through NHS prescription channels. The oral administration route eliminates hospital admission costs for uncomplicated cases, and the short treatment duration minimises both direct medical costs and indirect costs related to lost productivity.

Screening programmes targeting high-risk populations before initiating immunosuppressive therapy demonstrate clear cost-effectiveness by preventing catastrophic hyperinfection syndrome cases. The cost of serological screening plus presumptive treatment for positive individuals is substantially lower than the intensive care costs, prolonged hospitalisations, and high mortality rates associated with undetected strongyloidiasis progressing to severe disease. Economic analyses consistently support proactive screening approaches for immigrants from endemic countries and individuals with relevant travel histories before planned immunosuppression.

The availability of generic ivermectin formulations, including Iverheal 6 MG, enhances cost-effectiveness whilst maintaining therapeutic quality through MHRA regulatory oversight. The UK's integrated healthcare system allows for rational deployment of screening and treatment resources, targeting high-risk populations whilst avoiding unnecessary testing in low-risk individuals. This balanced approach optimises resource utilisation whilst ensuring that adults who would benefit from treatment receive timely intervention.

Frequently Asked Questions

What is strongyloidiasis and how do adults contract it?

Strongyloidiasis is a parasitic infection caused by the threadworm Strongyloides stercoralis, which penetrates intact skin upon contact with contaminated soil. Adults typically contract the infection by walking barefoot on soil containing infective larvae in tropical and subtropical regions. 

How long does ivermectin treatment take to work?

Ivermectin begins killing Strongyloides parasites within hours of administration, though complete symptom resolution may take several weeks. Most adults notice improvement in gastrointestinal symptoms within three to seven days of completing treatment. However, complete parasite clearance and definitive cure confirmation requires follow-up stool examinations at three and six months post-treatment. 

Can strongyloidiasis recur after successful treatment?

True recurrence after documented cure is uncommon unless reinfection occurs through renewed exposure to contaminated soil in endemic areas. However, treatment failure does occur in approximately five to ten percent of cases, usually due to larvae at developmental stages less susceptible to ivermectin at the time of treatment. 

Is ivermectin safe for elderly adults?

Ivermectin demonstrates an excellent safety profile in elderly adults, with no specific age-related contraindications. However, older patients may have reduced hepatic function or concurrent medical conditions requiring consideration during treatment planning. The standard dosing regimen based on body weight remains appropriate for elderly individuals, though those with significant liver or kidney disease may warrant closer monitoring. 

What dietary restrictions apply during ivermectin treatment?

Ivermectin should be taken on an empty stomach, ideally at least one hour before or two hours after meals, as food can reduce absorption and diminish therapeutic efficacy. Patients should avoid consuming grapefruit or grapefruit juice during treatment, as these can affect medication metabolism through CYP3A4 inhibition. Alcohol should be avoided during treatment and for twenty-four hours following the final dose. 

How is strongyloidiasis diagnosed in the UK?

Diagnosis in the UK typically involves a combination of clinical history, particularly travel or residence in endemic areas, and laboratory testing. Stool examinations using enhanced techniques like agar plate culture or Baermann concentration offer the most specific diagnosis when positive, though negative results do not exclude infection. Serological testing through ELISA detecting antibodies against Strongyloides antigens provides higher sensitivity and is widely available through NHS laboratories. 

What should I do if I experience side effects from ivermectin?

Mild side effects such as nausea, headache, or dizziness typically resolve without intervention and do not require treatment discontinuation. Taking simple analgesics like paracetamol can help manage headache or mild discomfort. If you experience more concerning symptoms such as severe abdominal pain, persistent vomiting, significant skin reactions, or neurological symptoms like confusion or severe dizziness, contact your healthcare provider promptly. 

Can I work or drive after taking ivermectin?

Most adults can continue normal activities including work and driving after taking ivermectin, as the medication does not typically cause significant sedation or impairment. However, some individuals experience mild dizziness or fatigue, particularly after the first dose. 

Is screening for strongyloidiasis necessary before starting corticosteroids?

Screening before initiating corticosteroid therapy is strongly recommended for adults with any history of residence in or travel to endemic regions, regardless of how long ago the exposure occurred. The risk of developing fatal hyperinfection syndrome when immunosuppression unmasks chronic strongyloidiasis far outweighs the minimal risks and costs of screening and presumptive treatment. 

Where can I obtain ivermectin treatment in the UK?

Ivermectin for strongyloidiasis is available through NHS prescription from your general practitioner, infectious disease specialist, or tropical medicine consultant. Following diagnosis or identification of high-risk status, your healthcare provider will issue a prescription that can be filled at any NHS or private pharmacy.