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Hilo Medical Center Updates Early Treatment Protocol for Rat Lungworm

Dr Doug Calvert, Dr Jon Martell
Dr. Jon Martell (right) shares strengthened treatment protocols on Rat Lungworm with Emergency Department physician, Dr. Doug Calvert.

Immediate Release: January 15, 2020

Hilo, Hawaii – In response to recent research and treatment recommendations, Hilo Medical Center has updated its treatment protocol for Rat Lungworm or Angiostrongylus cantonensis for practitioners in the Emergency Department or other outpatient clinics.

“Information we learned from the recent international Rat Lungworm conference is promising and has encouraged us to strengthen our treatment protocol,” says. Dr. Jon Martell, Chief Medical Officer at Hilo Medical Center and Rat Lungworm expert. “I have updated the treatment recommendations for Rat Lungworm in an effort to improve the process for patients and providers.”

Use of Pinworm Medication in Preventive Measures

An unpublished study, “In vitro efficacy of anthelmintic drugs on Angiostrongylus cantonensis L3 larvae,” authored by researchers John Jacob, Ingo Lange, Ghee Tan and Susan Jarvi at the University of Hawaii at Hilo’s Daniel K. Inouye College of Pharmacy, pyrantel pamoate, commonly known as pinworm medication, has been shown to immobilize A. cantonensis larvae (L3) in vitro. This data suggests the potential of immobilizing ingested Angiostrongylus larvae as well, which could then be expelled through stool without causing an infection, if given early. Clinical trials have not been done for treatment after exposure through eating a snail or slug, so this is not a proven treatment.

“Based on this recent research, we will inform patients that pinworm medication might have benefit if taken immediately after accidental consumption of a snail or slug,” says Dr. Martell. “The potential, though not proven, benefits appear to outweigh the minimal risk of the treatment. Snails and slugs in East Hawaii often carry the parasite and the pinworm medicine is available over-the-counter and safe if given as instructed on the package. We are recommending that people who have been exposed read the patient information for the medication and make an informed decision. The sooner you take the pinworm medication the more likely it is to help. We also recommend that you get the snail or slug tested later if you can, and absolutely go to see your primary care provider within a couple of days for assessment and possible use of additional treatment.”

Updated Treatment Guidelines for Albendazole for Children

Treatment recommendations for children who have swallowed a snail or slug using the antiparasitic medication, albendazole, were updated based on the September 2019 Children’s Health Queensland Hospital and Health Services, “Paediatric guideline: Snail and slug ingestion (Prophylaxis against Angiostrongylus cantonensis infection).”

“We are making this information public and are recommending that patients and physicians use this information to make an informed decision about whether they want to follow the Australian guidelines,” says Dr. Martell.

As the leading hospital in the country for diagnosing and treating Rat Lungworm, Hilo Medical Center has made this information available on our website and will initiate an education program for providers and the public.

Hilo Medical Center hosts and facilitates the Rat Lungworm Support Group on the second Wednesday of the month from 4:00-6:00 pm at the Keaau Community Center. Survivors of Rat Lungworm, their caregivers, and other supporters are invited to join in-person and via the Zoom online meeting platform. For more information, go to:


About the East Hawaii Region of Hawaii Health Systems Corporation

As the Big Island’s leading providers of inpatient and outpatient care, the East Hawaii Region of Hawaii Health Systems Corporation (HHSC), consisting of Hilo Medical Center, Hale Ho′ola Hamakua and Ka′u Hospital, delivers a full range of services and programs. Our three hospitals include 290 beds and over 1,300 employees. Our medical staff is comprised of 250 physicians, physician assistants and Advanced Practice Registered Nurses, representing 33 specialties. The region has a network of 13 outpatient clinics offering primary and specialty care. Hilo Medical Center functions as a Level III Trauma Center, which includes the second busiest emergency room in the state, providing 24-hour care and serving more than 50,000 patients annually. Hale Ho′ola Hamakua and Ka′u Hospital are designated as Critical Access Hospitals.

The East Hawaii Region of HHSC is part of the Hawaii Health Systems Corporation, a public entity established in 1996 by the State of Hawaii to fulfill the promise to provide quality, hometown healthcare. For more information, go to:, or