Implementation and Outcomes of an Empiric Ivermectin Strongyloides Treatment Protocol for Patients Receiving High-Dose Corticosteroids for Severe COVID-19

Strongyloides stercoralis is a parasitic roundworm that is present worldwide and can cause lifelong, often asymptomatic, infection. Immunosuppression, particularly by corticosteroids, is a risk factor for hyperinfection syndrome and disseminated strongyloidiasis—severe disease states that can lead to septic shock and death. Our institution implemented a strongyloidiasis screening and empiric ivermectin treatment protocol for inpatients receiving high-dose corticosteroids for severe COVID-19. Among 487 COVID-19 admissions treated with high-dose corticosteroids from June 10, 2020 to March 31, 2021, 61% of those with demographics at risk for Strongyloides exposure were screened for Strongyloides and treated empirically with ivermectin. Adherence to the protocol declined over time during the study period. The empiric ivermectin protocol appeared safe, but more research is needed to determine the effect on hyperinfection and/or disseminated strongyloidiasis risk and mortality rate, as well as to improve institutional adherence to the protocol.