'Preventive' deworming post-travel

[swrdfsh53]

I am a doctor and could use some input. Patient is a healthy 17 y/o WM who will be spending one month in remote areas of Thailand. He will be living with locals, swimming, eating, walking barefoot, etc. His mom inquired whether or not he should de-worm upon return to the USA, as many parasites are without symptoms until the disease has progressed. If de-worming is advised, what is the preferable agent, given the 'shotgun' approach to asymptomatic treatment?
Off hand, it seems a reasonable intervention. Any advice?

[Philip D Parks, MD, MPH, MOccH, FACOEM]

As a fellow provider, I am sure that you'll agree that the 'shotgun' approach in medicine with diagnostic testing and/or treatments is usually not effective due to sensitivity and specificity of diagnostics as well as treatments.

However, in general, if travelers, who are otherwise in good general health, have been traveling in high risk areas for substantial lengths of time, it is reasonable to consider anti-helminth prophylaxis upon departure. A relatively safe and effective option (in asymptomatic individuals) to consider is a one day treatment of albendazole + praziquantel. The combination of these two medications will cover most helminths (worms). The addition of praziquantel can be very important with people traveling to areas with endemic schistosomiasis.

I assume that your patient will also be taking anti-malarial prophylaxis as well...yes?

~•~ Dr. Parks

This answer is not intended as and does not substitute for medical or legal advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[swrdfsh53]

Thank you for well-considered response. It was very helpful. The young man has been fully immunized for the trip and has received anti-malarials.