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54 CPD ACTIVITY FROM PAGE 53 infection. However, gastrointestinal symptoms such as abdominal pain, diarrhoea, blood in the stools, and failure to thrive can occur if the worm burden is very high. The most common health indicators affected by chronic STH infestation include iron status, nutrition and growth, vitamin A status, and cognitive development. Further work is needed to elucidate the complex relationship between STHs and other infections in vulnerable populations.32 Other manifestations such as hydatid cyst formation (more commonly seen in people from farming communities) or tapeworm brain cysts require more structure diagnostic investigation. Management A high-level summary of common anthelmintics is provided in Table 2. Regular ‘deworming’ is not necessary in most Australian populations. However, programs in communities with high rates of helminth infection involve administration of albendazole (400mg- 200mg in children 10kg or less) as a single dose once a year. The aim of the program is to improve nutrition and growth which can be affected by chronic infection.36 Prevention of spread of helminth infections involves diligently washing children’s hands after toileting and before eating, changing bed linen and underwear daily after worm treatment, washing bed linen and clothes in hot water to kill eggs, and keeping toilet seats and potties clean and fingernails short. Pharmacist’s role Many different products are available to treat (and prevent) ecto- and endoparasites. Pharmacists have an important role to play in educating the public on the different treatment options and prevention strategies. Because none of the current products for head lice provides 100 per cent efficacy if used alone, pharmacists should emphasise correct use – including adhering to recommended time intervals, potential adverse effects and to seek further advise if unsure. Patient information materials concerning the diagnosis, treatment and prevention of head lice are available at schools and local health departments (including sensitivity information for various head lice treatments per state and territory jurisdiction). References available by request. Table 2. Use of Anthelmintics in children Medication Comment Reference Albendazole • At the dosage recommended for STH treatment, the incidence of side effects is very low. • Used in children >6 months. 33 Mebendazole • The most recent evidence comes from a placebo controlled randomised trial where there was no increase in the incidence of any side effects in children (aged 6–59 months) treated with mebendazole (500mg) compared to the control group. • Used in children >6 months. 34 Pyrantel • In a study of 1506 individuals including children under five years of age, side effects were mild and transient and included occasional diarrhoea (4.3%), abdominal pain (4%), nausea (3.5%), vomiting (2%), and headache (3%). 35 Ivermectin • Two doses given over seven to 14 days for strongyloidiasis in immunocompetent patients. Infection in immunocompromised patients can be fatal and requires a more intensive ivermectin regimen. • 200mg/kg used in children >5 years and/or >15kg 36 Praziquantel OR niclosamide • First and second line respectively for tapeworm • Active tapeworm cysts in the brain can cause seizures and may require antiepileptic therapy. Albendazole and corticosteroids may also be used in this case. • Well tolerated in short courses 36 Levamisole (not registered in Australia) • No literature was found specifically on the use of levamisole in pre-school age children. However, levamisole has been successfully used for mass administration in Asia, Vietnam, South America and Africa. 25 Head lice, scabies and worms 2 CPD CREDITS Accreditation number: A2102RP1 (exp:31/01/2023). This activity has been accredited for 1 hour of Group One CPD (or 1 CPD credit) suitable for inclusion in an individual pharmacist’s CPD plan, which may be converted to 1 hour of Group Two CPD (or 2 CPD credits) upon successful completion of the associated assessment activity. 1. Which of the following is true about head lice? A) Head lice infestation is most common among people between 14 and 22 years of age. B) Head lice are responsible for transmitting or spreading diseases. C) Adult head louse is 1-2mm long, has six legs and is usually tan to grayish-white in colour. D) Besides crawling, head lice can also fly or hop. E) Noneoftheabove. 2. Which of the following is true about permethrin? A) It’s one of the drugs of choice for head lice infestation. B) Use of permethrin is commonly associated with adverse effects such as headache and otitis media. C) To treat infestation, permethrin should be applied to dry hair and left to air dry. D) Many experts now recommend one-time treatment to be sufficient for head lice infestation. E) None of the above. 3. If a child is diagnosed with head lice infestation, which of the following would be an appropriate action step? A) OTC permethrin 1% or pyrethrins should be first attempted for treatment. B) The child should still be allowed to share combs, brushes and hats with other people. C) Permethrin lotion should be applied after washing hair with conditioning shampoo with silicone-based additives to enhance its treatment effect. D) Malathion 0.5% should be prescribed if the patient is six months old. E) Noneoftheabove. 4. All household family members of a child diagnosed with head lice infestation A) Should be checked for head lice. B) Should receive treatment if they have shared the same bed with the diagnosed child. C) Should understand that head lice are a sign of poor hygiene and a health hazard. D) Only A and B are correct. E) A,B,andCarecorrect. 5. Which of the following is true? A) The most common health indicators affected by low level soil-transmitted helminth infections include iron status, nutrition and growth, vitamin A status and cognitive development. B) The most common soil-transmitted helminth in Australia is roundworm. C) Programs involving yearly ‘deworming’ treatment exist in at-risk Australian populations. D) Prevention of spread of soil-transmitted helminth infections is only possible with oral anthelmintics. E) None of the above. RETAIL PHARMACY • JAN/FEB 2021