Elsevier

Acta Tropica

Volume 202, February 2020, 105249
Acta Tropica

Ivermectin concentration in breastmilk of a woman with Strongyloides stercoralis and human T-lymphotropic virus-I co-infection

https://doi.org/10.1016/j.actatropica.2019.105249Get rights and content

Highlights

  • Published studies of ivermectin (IVM) use in children and pregnant/nursing women are few.

  • Levels of IVM in breastmilk of threated mothers are low and infant exposure appears negligible.

  • There is no reason to exclude lactating women from the beneficial effects of IVM therapy or to interrupt lactation to prevent infant exposure.

  • The results of this report support the current WHO policy, which excludes lactating women from IVM therapy only in the first week after delivery.

Abstract

Ivermectin is a widely used drug for the treatment of various neglected tropical diseases, such as lymphatic filariasis, onchocerciasis, and strongyloidiasis among others. Despite its excellent safety profile, there are few published studies of the use of ivermectin in children, pregnant and nursing women. In the present study, we report clinical data on ivermectin concentrations in breastmilk of a woman with Strongyloides stercoralis and HTLV-I coinfection. Ivermectin levels in breastmilk ranged from 1.4 to 20.8 ng/ml, with a mean of 9.26 ng/ml after a single dose of 200 µg/kg. We estimated the possible ivermectin exposure of the infant to be 1.1 µg/kg, 0.55% of the weight-adjusted percentage of the maternal dose. This value is largely under the threshold established by the World Health Organization for safe breastfeeding. Our results bolster previous findings on the secretion of ivermectin into breastmilk in healthy volunteers. The findings from this case study do not support exclusion of lactating women or interrupting lactation to accommodate it.

Section snippets

Report

Ivermectin (IVM) is a broad-spectrum anti-parasitic agent, highly active against most nematodes (including Strongyloides stercoralis), as well as ectoparasites (i.e. Sarcoptes scabiei and Pediculus spp). Moreover, it is effective in killing a number of insects, including mosquitoes (for instance Anopheles gambiae, vector of Plasmodium falciparum malaria), and inhibiting replication of several flaviviruses (Crump, 2017). For these reasons, IVM is considered a “wonder drug”, and its discovery

Ethics

The patient gave her written informed consent for the publication of this case report.

Funding

This work was supported by the Italian Ministry of Health “Fondi Ricerca corrente – Linea 2, progetto 4” to IRCCS Sacro Cuore – Don Calabria Hospital.

CRediT authorship contribution statement

Paola Rodari: Conceptualization, Investigation, Project administration, Writing - original draft. Dora Buonfrate: Writing - original draft, Writing - review & editing. Elena Pomari: Formal analysis, Methodology, Writing - review & editing. Gianluigi Lunardi: Formal analysis, Methodology, Writing - review & editing. Isabella Bon: Formal analysis, Methodology, Writing - review & editing. Zeno Bisoffi: Writing - original draft, Writing - review & editing. Andrea Angheben: Conceptualization,

Declaration of Competing Interest

The authors declare that they have no conflict of interest.

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