The latest Paper of the Month for Parasitology is Ivermectin vs moxidectin for treating Strongyloides stercoralis infection: a systematic review and is freely available as open access

The microscopic parasite Strongyloides stercoralis infects millions of humans worldwide, often without symptoms. For years, the treatment of choice has been ivermectin, a drug that has been recognized for its use in combating diseases, such as river blindness. However, what is another option? Our recent study compared ivermectin to its lesser-known antiparasitic, moxidectin, and the results were promising.

The Problem: Strongyloidiasis, an infection caused by this parasite, is sneaky. Many people do not even know that they have it because they live in the guts of infected people. The infection is not serious for most, but for those with weakened immune systems, it can be fatal. People become infected when they come into contact with soil or water contaminated with infectious worms. Chronic infection usually causes skin rash, vomiting, diarrhea, constipation, and respiratory problems such as asthma‐like illnesses. The parasite thrives in tropical regions but also pops up in non-endemic areas due to travel and migration. Diagnosis of this condition is complicated, and treatment options are limited.

What our research says: we analyzed two clinical trials involving over 800 adults in Southeast Asia. They compared moxidectin (a drug widely used in veterinary medicine) with ivermectin. Moxidectin worked just as well as ivermectin in curing chronic strongyloidiasis, with similar mild side effects like headaches and stomach pain. No serious reactions were reported and, importantly, none of the patients died from either treatment.

Why This Matters: Implications for the future:

New Option, Same Safety: Moxidectin is not inferior to ivermectin, giving doctors another tool.

Weight Does not Matter: Unlike ivermectin, which requires weight-based dosing, moxidectin uses a fixed dose, simplifying treatment in resource-poor settings.

Resistance problem: With ivermectin being used globally for other diseases, resistance can emerge. Moxidectin offers a backup.

However, the study did not include children, the elderly, or immunocompromised patients (who are most at risk of severe cases). The current data are insufficient to make a conclusive statement regarding appropriate management, and further research is needed. However, this is good news for an average healthy adult.

Big Picture: This is not only about one parasite. It is about preparing for global health challenges, whether fighting neglected diseases or ensuring treatment options. However, more research is needed, as well-designed trials may help investigate the effect in different groups of patients to facilitate adherence.

So next time you hear about “moxidectin,” think of it as ivermectin’s alternative for treating Strongyloides stercoralis infections.

The paper Ivermectin vs moxidectin for treating Strongyloides stercoralis infection: a systematic review by Cesar Henriquez-Camacho, Jose A. Pérez-Molina, Dora Buonfrate, Paola Rodari ,Eduardo Gotuzzo ,Benilde Luengo and María Nieves Plana, published in Parasitology, is freely available as open access.