Hookworm infection is an infection by a type of intestinal parasite known as a hookworm. Initially, itching and a rash may occur at the site of infection. Those only affected by a few worms may show no symptoms. Those infected by many worms may experience abdominal pain, diarrhea, weight loss, and tiredness. The mental and physical development of children may be affected. Anemia may result.Two common hookworm infections in humans are ancylostomiasis and necatoriasis, caused by the species Ancylostoma duodenale and Necator americanus respectively. Hookworm eggs are deposited in the stools of infected people. If these end up in the environment, they can hatch into larvae (immature worms), which can then penetrate the skin. One type can also be spread through contaminated food. Risk factors include walking barefoot in warm climates, where sanitation is poor. Diagnosis is by examination of a stool sample with a microscope.The disease can be prevented on an individual level by not walking barefoot in areas where the disease is common. At a population level, decreasing outdoor defecation, not using raw feces as fertilizer, and mass deworming is effective. Treatment is typically with the medications albendazole or mebendazole for one to three days. Iron supplements may be needed in those with anemia.Hookworms infected about 428 million people in 2015. Heavy infections can occur in both children and adults, but are less common in adults. They are rarely fatal. Hookworm infection is a soil-transmitted helminthiasis and classified as a neglected tropical disease.
In September 2013,  Merck & Co. sold the U.S. rights to their ophthalmic product line (including Cosopt) to Akorn Inc. for $52.8 million cash.Upon the original patent expiration, Hi-Tech Pharma was the first of many generic competitors to submit an abbreviated new drug application (ANDA) for dorzolamide hydrochloride/timolol maleate eye drops. Hi-Tech Pharmas ANDA was approved on 28 October 2008. At the time, controversy surrounded the approval of this first ANDA. Hi-Tech sued the FDA for their right to 180 market exclusivity as laid out in the Hatch-Waxman Act. Apotex, another firm seeking an ANDA approval for generic Cosopt, argued that Hi-Tech "forfeited its rights to market exclusivity because it has failed to market the drug within 30 months of its ANDA submission or within 75 days after Merck withdrew its patent information." The FDA upheld their previous exclusivity decisions on acarbose and granisetron, allowing both Hi-Tech and Apotex to make a generic version of Cosopt. Soon after, ANDAs from Sandoz, Bausch & Laumb, TEVA and others were also approved.Just over a year before Merck sold their ophthalmic line to Akorn, Akorn developed a new formulation of dorzolamide hydrochloride/timolol maleate called Cosopt PF, which is simply a preservative free formulation of Cosopt. It gained FDA approval in July 2012 and is currently protected by market exclusivity. Society and culture
Legality
In the United States, Cosopt, as well as its generics, is only available to patients with a valid prescription.