**10. Treatment**

Early identification of the disease and anthelminthic treatment results in a better prognosis for strongyloidiasis and, in many cases, prevents a fatal infection (Basile et al., 2010). *S. stercoralis* is resistant to anthelmintic drugs, and the parasite has the capacity to replicate and increase the worm burden again (Grove, 1996).

Thiabendazole, albendazole, and mebendazole are effective drugs against *S. stercoralis.* Thiabendazole was the drug of choice for treatment of strongyloidiasis, with a cure rate of up to 80%. Albendazole has variable therapeutic efficacy but has been used in hyperinfection syndrome and remains a viable treatment alternative to ivermectin. Mebendazole can be used to treat strongyloidiasis but is not recommended because of an association with liver dysfunction (Rajapurkar et al., 2007). Recently, there has been a change in the treatment of strongyloidiasis, as more studies support the choice of the drug ivermectin, which is effective at killing worms in the intestine. In patients with hyperinfection syndrome, ivermectin is considered the first-line therapy, and longer courses of treatment are indicated (Roxby et al., 2009).

Efficient treatment of strongyloidiasis depends on several factors that can decrease the efficacy of the drugs used for treatment, such as immunodeficiency, corticosteroid use, or co-infection with HTLV-1 (Vadlamudi et al., 2006). Prolonged or repeated treatment may be required in patients receiving immunosuppressive drugs.

Other measures, including decreasing the dosage of corticosteroids, discontinuing immunosuppressive therapies and treating bacterial infections, are essential elements in the treatment of these patients. In all cases, patients with strongyloidiasis, regardless of the severity of symptoms, must be treated to prevent long-term complications (Montes et al., 2010).
