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Anthelmintics or antihelminthics are a group of antiparasitic drugs that expel parasitic worms (
helminths Parasitic worms, also known as helminths, are large macroparasites; adults can generally be seen with the naked eye. Many are intestinal worms that are soil-transmitted and infect the gastrointestinal tract. Other parasitic worms such as ...
) and other internal parasites from the body by either stunning or killing them and without causing significant damage to the host. They may also be called vermifuges (those that stun) or vermicides (those that kill). Anthelmintics are used to treat people who are infected by helminths, a condition called
helminthiasis Helminthiasis, also known as worm infection, is any macroparasitic disease of humans and other animals in which a part of the body is infected with parasitic worms, known as helminths. There are numerous species of these parasites, which are ...
. These drugs are also used to treat infected animals. Pills containing anthelmintics are used in mass deworming campaigns of school-aged children in many developing countries. The drugs of choice for soil-transmitted helminths are
mebendazole Mebendazole (MBZ), sold under the brand name Vermox among others, is a medication used to treat a number of parasitic worm infestations. This includes ascariasis, pinworm infection, hookworm infections, guinea worm infections, hydatid disea ...
and
albendazole Albendazole (also known as albendazolum) is a broad-spectrum anthelmintic and antiprotozoal agent of the benzimidazole type. It is used for the treatment of a variety of intestinal parasite infections, including ascariasis, pinworm infection, ho ...
; for
schistosomiasis Schistosomiasis, also known as snail fever, bilharzia, and Katayama fever, is a disease caused by parasitic flatworms called schistosomes. The urinary tract or the intestines may be infected. Symptoms include abdominal pain, diarrhea, blo ...
and
tapeworms Cestoda is a class of parasitic worms in the flatworm phylum (Platyhelminthes). Most of the species—and the best-known—are those in the subclass Eucestoda; they are ribbon-like worms as adults, known as tapeworms. Their bodies consist of ...
it is
praziquantel Praziquantel (PZQ), sold under the brandname Biltricide among others, is a medication used to treat a number of types of parasitic worm infections in mammals, birds, amphibians, reptiles, and fish. In humans specifically, it is used to treat sc ...
.


Types

Antiparasitics that specifically target worms of the genus ''
Ascaris ''Ascaris'' is a genus of parasitic nematode worms known as the "small intestinal roundworms", which is a type of parasitic worm. One species, '' Ascaris lumbricoides'', affects humans and causes the disease ascariasis. Another species, ''Ascar ...
'' are called
ascaricides Ascaricides are drugs to treat ascariasis that is caused by infections with parasitic nematodes (''roundworms'') of the genus ''Ascaris'' (''giant intestinal roundworms''). The large roundworm of pigs (''Ascaris suum'') typically infects pigs whil ...
. *
Benzimidazoles Benzimidazole is a heterocyclic aromatic organic compound. This bicyclic compound may be viewed as fused rings of the aromatic compounds benzene and imidazole. It is a colorless solid. Preparation Benzimidazole is produced by condensation of o ...
: **
Albendazole Albendazole (also known as albendazolum) is a broad-spectrum anthelmintic and antiprotozoal agent of the benzimidazole type. It is used for the treatment of a variety of intestinal parasite infections, including ascariasis, pinworm infection, ho ...
– effective against threadworms,
roundworms The nematodes ( or grc-gre, Νηματώδη; la, Nematoda) or roundworms constitute the phylum Nematoda (also called Nemathelminthes), with plant-parasitic nematodes also known as eelworms. They are a diverse animal phylum inhabiting a broa ...
,
whipworms ''Trichuris trichiura, Trichocephalus trichiuris'' or whipworm, is a parasitic roundworm (a type of helminth) that causes trichuriasis (a type of helminthiasis which is one of the neglected tropical diseases) when it infects a human large intest ...
,
tapeworms Cestoda is a class of parasitic worms in the flatworm phylum (Platyhelminthes). Most of the species—and the best-known—are those in the subclass Eucestoda; they are ribbon-like worms as adults, known as tapeworms. Their bodies consist of ...
,
hookworms Hookworms are intestinal, blood-feeding, parasitic roundworms that cause types of infection known as helminthiases. Hookworm infection is found in many parts of the world, and is common in areas with poor access to adequate water, sanitation, an ...
**
Mebendazole Mebendazole (MBZ), sold under the brand name Vermox among others, is a medication used to treat a number of parasitic worm infestations. This includes ascariasis, pinworm infection, hookworm infections, guinea worm infections, hydatid disea ...
– effective against various nematodes **
Thiabendazole Tiabendazole (INN, BAN), also known as thiabendazole (AAN, USAN) or TBZ and the trade names Mintezol, Tresaderm, and Arbotect, is a preservative, an antifungal agent, and an antiparasitic agent. Uses Preservative Tiabendazole is used primar ...
– effective against various nematodes **
Fenbendazole Fenbendazole is a broad spectrum benzimidazole anthelmintic used against gastrointestinal parasites including: giardia, roundworms, hookworms, whipworms, the tapeworm genus '' Taenia'' (but not effective against '' Dipylidium caninum'', a comm ...
– effective against various parasites **
Triclabendazole Triclabendazole, sold under the brand name Egaten among others, is a medication used to treat fascioliasis and paragonimiasis. It is very effective for both conditions. Treatment in hospital may be required. It is taken by mouth with typically ...
– effective against liver flukes **
Flubendazole Flubendazole is an anthelmintic. Its brand name is Flutelmium which is a paste manufactured by Janssen Pharmaceutica N.V. used by veterinarians for protection against internal parasites and worms in dogs and cats. Other brand names are Flubenol, ...
– effective against most intestinal parasites *
Avermectins The avermectins are a series of drugs and pesticides used to treat parasitic worms and insect pests. They are a group of 16-membered macrocyclic lactone derivatives with potent anthelmintic and insecticidal properties. These naturally occurrin ...
(including
ivermectin Ivermectin (, '' EYE-vər-MEK-tin'') is an antiparasitic drug. After its discovery in 1975, its first uses were in veterinary medicine to prevent and treat heartworm and acariasis. Approved for human use in 1987, today it is used to treat i ...
) - effective against most common intestinal worms, except tapeworms, for which
praziquantel Praziquantel (PZQ), sold under the brandname Biltricide among others, is a medication used to treat a number of types of parasitic worm infections in mammals, birds, amphibians, reptiles, and fish. In humans specifically, it is used to treat sc ...
is commonly used in conjunction for mass dewormings *
Diethylcarbamazine Diethylcarbamazine is a medication used in the treatment of filariasis including lymphatic filariasis, tropical pulmonary eosinophilia, and loiasis. It may also be used for prevention of loiasis in those at high risk. While it has been used for ...
– effective against ''
Wuchereria bancrofti ''Wuchereria bancrofti'' is a filarial (arthropod-borne) nematode (roundworm) that is the major cause of lymphatic filariasis. It is one of the three parasitic worms, together with ''Brugia malayi'' and '' B. timori'', that infect the lymphatic ...
'', ''
Brugia malayi ''Brugia malayi'' is a filarial (arthropod-borne) nematode (roundworm), one of the three causative agents of lymphatic filariasis in humans. Lymphatic filariasis, also known as elephantiasis, is a condition characterized by swelling of the lower l ...
'', ''
Brugia timori ''Brugia timori'' is a filarial (arthropod-borne) nematode (roundworm) which causes the disease "Timor filariasis", or "Timorian filariasis". While this disease was first described in 1965, the identity of ''Brugia timori'' as the causative agen ...
'', and ''
Loa loa ''Loa loa'' is a filarial (arthropod-borne) nematode (roundworm) that causes ''Loa loa'' filariasis. ''Loa loa'' actually means "worm worm", but is commonly known as the "eye worm", as it localizes to the conjunctiva of the eye. ''Loa loa'' is ...
'' *
Pyrantel pamoate Pyrantel is a medication used to treat a number of parasitic worm infections. This includes ascariasis, hookworm infections, enterobiasis (pinworm infection), trichostrongyliasis, and trichinellosis. It is taken by mouth. Side effects inclu ...
– effective against most nematode infections residing within the intestines *
Levamisole Levamisole, sold under the brand name Ergamisol among others, is a medication used to treat parasitic worm infections, specifically ascariasis and hookworm infections. It is taken by mouth. Side effects may include abdominal pain, vomiting, ...
* Salicylanilide – mitochondrial un-couplers (used only for flatworm infections): **
Niclosamide Niclosamide, sold under the brand name Niclocide among others, is an anthelmintic medication used to treat tapeworm infestations, including diphyllobothriasis, hymenolepiasis, and taeniasis. It is not effective against other worms such as flukes ...
** Oxyclozanide *
Nitazoxanide Nitazoxanide, sold under the brand name Alinia among others, is a broad-spectrum antiparasitic and broad-spectrum antiviral medication that is used in medicine for the treatment of various helminthic, protozoal, and viral infections. It is ind ...
– readily kills ''
Ascaris lumbricoides ''Ascaris lumbricoides'' is a large parasitic worm that causes ascariasis in humans. A roundworm of genus ''Ascaris'', it is the most common parasitic worm in humans. An estimated one-sixth of the human population is at some point infected by ...
'', and also possess antiprotozoal effects *
Oxamniquine Oxamniquine, sold under the brand name Vansil among others, is a medication used to treat schistosomiasis due to ''Schistosoma mansoni''. Praziquantel, however, is often the preferred treatment. It is given by mouth and used as a single dose. Co ...
– effective against
flatworms The flatworms, flat worms, Platyhelminthes, or platyhelminths (from the Greek πλατύ, ''platy'', meaning "flat" and ἕλμινς (root: ἑλμινθ-), ''helminth-'', meaning "worm") are a phylum of relatively simple bilaterian, unsegment ...
(e.g., tapeworms and
schistosoma ''Schistosoma'' is a genus of trematodes, commonly known as blood flukes. They are parasitic flatworms responsible for a highly significant group of infections in humans termed '' schistosomiasis'', which is considered by the World Health Org ...
) *
Praziquantel Praziquantel (PZQ), sold under the brandname Biltricide among others, is a medication used to treat a number of types of parasitic worm infections in mammals, birds, amphibians, reptiles, and fish. In humans specifically, it is used to treat sc ...
– effective against
flatworms The flatworms, flat worms, Platyhelminthes, or platyhelminths (from the Greek πλατύ, ''platy'', meaning "flat" and ἕλμινς (root: ἑλμινθ-), ''helminth-'', meaning "worm") are a phylum of relatively simple bilaterian, unsegment ...
(e.g., tapeworms and
schistosoma ''Schistosoma'' is a genus of trematodes, commonly known as blood flukes. They are parasitic flatworms responsible for a highly significant group of infections in humans termed '' schistosomiasis'', which is considered by the World Health Org ...
) * Octadepsipeptides (e.g.
Emodepside Emodepside is an anthelmintic drug that is effective against a number of gastrointestinal nematodes, is licensed for use in cats and belongs to the class of drugs known as the ''octadepsipeptides'', a relatively new class of anthelmintic (research ...
) – effective against a variety of gastrointestinal helminths * Monepantel (aminoacetonitrile class) - effective against a variety of nematodes including those resistant to other anthelmintic classes * Spiroindoles (e.g. derquantel) - effective against a variety of nematodes including those resistant to other anthelmintic classes *
Artemisinin Artemisinin () and its semisynthetic derivatives are a group of drugs used in the treatment of malaria due to '' Plasmodium falciparum''. It was discovered in 1972 by Tu Youyou, who shared the 2015 Nobel Prize in Physiology or Medicine for h ...
– shows anthelmintic activity


Anthelmintic resistance

Anthelmintic resistance in parasites is now widespread. It is a major threat to the sustainability of modern ruminant livestock production, resulting in reduced productivity, compromised animal health and welfare, and increased greenhouse gas emissions through increased parasitism and farm inputs. A database of published and unpublished European AR research on gastrointestinal
nematodes The nematodes ( or grc-gre, Νηματώδη; la, Nematoda) or roundworms constitute the phylum Nematoda (also called Nemathelminthes), with plant-parasitic nematodes also known as eelworms. They are a diverse animal phylum inhabiting a broa ...
was collated in 2020. A total of 197 publications were available for analysis, representing 535 studies in 22 countries and spanning the period 1980–2020. Results in sheep and goats since 2010 reveal an average prevalence of resistance to
benzimidazoles Benzimidazole is a heterocyclic aromatic organic compound. This bicyclic compound may be viewed as fused rings of the aromatic compounds benzene and imidazole. It is a colorless solid. Preparation Benzimidazole is produced by condensation of o ...
of 86%, macrocyclic lactones except moxidectin 52%,
levamisole Levamisole, sold under the brand name Ergamisol among others, is a medication used to treat parasitic worm infections, specifically ascariasis and hookworm infections. It is taken by mouth. Side effects may include abdominal pain, vomiting, ...
48%, and moxidectin 21%. All major gastrointestinal
nematodes The nematodes ( or grc-gre, Νηματώδη; la, Nematoda) or roundworms constitute the phylum Nematoda (also called Nemathelminthes), with plant-parasitic nematodes also known as eelworms. They are a diverse animal phylum inhabiting a broa ...
genera survived treatment in various studies. In cattle, prevalence of anthelminthic resistance varied between anthelmintic classes from 0–100% (benzimidazoles and macrocyclic lactones), 0–17% (levamisole) and 0–73% (moxidectin), and both '' Cooperia'' and ''
Ostertagia ''Ostertagia'' is a genus of nematodes belonging to the family Trichostrongylidae. The genus has cosmopolitan distribution. Species: *'' Ostertagia antipini'' *'' Ostertagia arctica'' *'' Ostertagia buriatica'' *'' Ostertagia dahurica'' *' ...
'' survived treatment. The ability of parasites to survive treatments that are generally effective at the recommended doses is a major threat to the future control of worm parasites in small ruminants and horses. This is especially true of
nematode The nematodes ( or grc-gre, Νηματώδη; la, Nematoda) or roundworms constitute the phylum Nematoda (also called Nemathelminthes), with plant- parasitic nematodes also known as eelworms. They are a diverse animal phylum inhabiting a bro ...
s, and has helped spur development of aminoacetonitrile derivatives for treatment against drug-resistant nematodes, as well as exploration of
doxycycline Doxycycline is a broad-spectrum tetracycline class antibiotic used in the treatment of infections caused by bacteria and certain parasites. It is used to treat bacterial pneumonia, acne, chlamydia infections, Lyme disease, cholera, typhus ...
to kill their endosymbiotic ''
Wolbachia ''Wolbachia'' is a genus of intracellular bacteria that infects mainly arthropod species, including a high proportion of insects, and also some nematodes. It is one of the most common parasitic microbes, and is possibly the most common reproducti ...
'' bacteria. The resistance is measured by the " fecal egg count reduction" value which varies for different types of helminths. Treatment with an antihelminthic drug kills worms whose phenotype renders them susceptible to the drug, but resistant parasites survive and pass on their "resistance" genes. Resistant varieties accumulate, and treatment failure finally occurs.


See also

* ''
Dysphania ambrosioides ''Dysphania ambrosioides'', formerly ''Chenopodium ambrosioides'', known as Jesuit's tea, Mexican-tea, ''payqu'' ''(paico)'', ''epazote'', ''mastruz'', or ''herba sanctæ Mariæ'', is an annual or short-lived perennial herb native to Central ...
'', an herb native to Central and South America *
Santonin Santonin is a drug which was widely used in the past as an anthelminthic. It is an organic compound consisting of colorless flat prisms, turning slightly yellow from the action of light and soluble in alcohol, chloroform and boiling water. Accor ...
, a historical anthelmintic no longer in use


References


External links

* * Holden-Dye, L. and Walker, R.
Anthelmintic drugs
(November 2, 2007), WormBook, ed. The C. elegans Research Community, WormBook, doi/10.1895/wormbook.1.143.1 {{Authority control * Articles containing video clips