Background and importance A preliminary report of the RECOVERY trial revealed a survival benefit related to the use of dexamethasone in hospitalised patients with coronavirus disease 2019 (COVID-19) (CM1). However, corticosteroids have an uncommon, but preventable, complication associated with its immunosuppressive mechanism of action: Strongyloides stercoralis hyperinfection or dissemination syndrome. S stercoralis infection should be ruled out in patients from endemic areas before starting immunosuppressive treatment. As the results of the serological tests are not immediate, certain patients would benefit from preventive treatment with ivermectin.

Aim and objectives To evaluate the effectiveness and safety of ivermectin for prophylaxis of S stercoralis hyperinfection syndrome in COVID-19 patients from endemic zones treated with corticosteroids or immunosuppressive treatment.

Material and methods A retrospective observational study was performed in a tertiary level hospital including all COVID-19 patients from S stercoralis endemic areas and treated with prophylactic ivermectin between March 2020 and September 2020. Demographic and clinical features were obtained from the electronic patient clinical history (DIRAYA) and the electronic prescription programme (PRISMA). Effectiveness was defined as the non-presentation of S stercoralis hyperinfection or dissemination syndrome. Safety was evaluated describing adverse events (AE).

Results 35 COVID-19 patients from endemic areas were admitted and treated with ivermectin 6 mg/8 hours for 2 days. 52% of patients were women, with an average age of 42.84±11.38 years. The patients treated with ivermectin were from Latin America, and the most frequent countries were: 48% Bolivia, 24% Nicaragua, 12% Ecuador, 8% Colombia and 8% Peru. Immunosuppressive treatment was: 83% dexamethasone 6 mg/24 hours, 14% methylprednisolone bolus 250 mg, 12% tocilizumab 400 mg and 3% no immunosuppressive treatment. Three (9%) of the patients presented with positive S stercoralis serology. However, they did not develop S stercoralis hyperinfection or dissemination syndrome. Furthermore, no patient had eosinophilia, with an average eosinophiles blood count of 0.04±0.09×10³/μg. None of the patients had adverse events.

Conclusion and relevance Prophylactic treatment with ivermectin was safe. Patients from endemic areas who should start immunosuppressive treatment as soon as possible could be treated prophylactically with ivermectin. Nevertheless, the number of patients and positive cases were small and more studies are needed to generate evidence.

Conflict of interest No conflict of interest