Immediate therapy for unstable presentations
›Immediate therapy for unstable presentations
›Sepsis bundle alignment
›If shock, vasopressor titration to perfusion targets
›If severe metabolic derangement, targeted correction with close monitoring
›Hypoglycemia management
›IV dextrose bolus for symptomatic hypoglycemia
›Dextrose infusion if recurrent hypoglycemia
›Seizure management
›Benzodiazepine first line
›Levetiracetam or phenytoin loading per institutional protocol
›Anaphylaxis management
›If suspected hydatid cyst rupture with anaphylaxis, epinephrine protocol and airway readiness
›Antiparasitic regimens selection
›Severe malaria, initial parenteral therapy
›Artesunate IV 2.4 mg/kg at 0 hours
›Artesunate IV 2.4 mg/kg at 12 hours
›Artesunate IV 2.4 mg/kg at 24 hours
›Transition to complete oral antimalarial course after clinical improvement and parasite density decline
›Choice guided by species, resistance region, and local guidance
›Uncomplicated malaria, oral options
›Artemisinin-based combination therapy per local protocol
›Directly observed first dose when feasible
›Repeat smear plan to document clearance when indicated
›Strongyloidiasis, uncomplicated
›Ivermectin 200 microg/kg PO daily for 1 to 2 days
›Relative contraindication, suspected Loa loa coinfection
›Alternative, albendazole 400 mg PO twice daily for 7 days
›Schistosomiasis
›Praziquantel therapy
›Timing, at least 6 to 8 weeks after last freshwater exposure for travelers
›Specialist dosing protocol selection based on species and setting
›Neurocysticercosis, viable parenchymal disease
›Albendazole 15 mg/kg/day in 2 divided doses, typical 10 to 14 days, max 1200 mg/day
›Anti-inflammatory co-therapy planning to reduce treatment related edema
›Antiseizure therapy for seizure control and prevention
›Toxoplasmosis, severe or CNS disease concern
›Pyrimethamine based regimen with leucovorin to reduce marrow toxicity
›Sulfadiazine co-therapy when tolerated
›Infectious diseases consultation for regimen tailoring and duration
Supportive care and complications
›Supportive care and complications
›Fluids and electrolytes
›Oral rehydration for mild to moderate dehydration
›IV crystalloid for severe dehydration with frequent reassessment
›Electrolyte correction with repeat labs
›Anemia management
›Transfusion threshold individualized to symptoms and comorbidity
›Consider exchange transfusion discussion for extreme hyperparasitemia per specialist guidance
›Frequent hemoglobin monitoring in hemolysis pattern
›Medication safety checks
›QT prolongation risk review with antimalarials and co-medications
›G6PD status consideration for specific antimalarials where relevant
›Pregnancy compatible regimen selection
›Steroid caution in exposure risk
›If planned high dose steroids with Strongyloides risk, infectious diseases consultation and empiric ivermectin consideration