Doses of diazepam are recommended to be about half of those given to younger people, and treatment limited to a maximum of two weeks. Long-acting benzodiazepines such as diazepam are not recommended for the elderly. Diazepam can also be dangerous in geriatric patients owing to a significant increased risk of falls. Intravenous or intramuscular injections in hypotensive people or those in shock should be administered carefully and vital signs should be monitored. Benzodiazepines such as diazepam are lipophilic and rapidly penetrate membranes, so rapidly cross over into the placenta with significant uptake of the drug. Use of benzodiazepines including diazepam in late pregnancy, especially high doses, can result in floppy infant syndrome. Diazepam when taken late in pregnancy, during the third trimester, causes a definite risk of a severe benzodiazepine withdrawal syndrome in the neonate with symptoms including hypotonia, and reluctance to suck, to apnoeic spells, cyanosis, and impaired metabolic responses to cold stress. Floppy infant syndrome and sedation in the newborn may also occur. Symptoms of floppy infant syndrome and the neonatal benzodiazepine withdrawal syndrome have been reported to persist from hours to months after birth. Adverse effects
Adverse effects of benzodiazepines such as diazepam include anterograde amnesia, confusion (especially pronounced in higher doses) and sedation. The elderly are more prone to adverse effects of diazepam, such as confusion, amnesia, ataxia, and hangover effects, as well as falls. Long-term use of benzodiazepines such as diazepam is associated with drug tolerance, benzodiazepine dependence, and benzodiazepine withdrawal syndrome.
Clinical presentation
The majority of human infections are asymptomatic or associated with mild symptoms. Symptomatic individuals may experience abdominal pain, nausea, diarrhea, flatulence, dizziness, generalized fatigue, and malaise. Eosinophilia is frequently observed. Infections with a heavy worm burden can lead to anemia, cholecystitis, and emaciation. Regarding Trichostrongylus retortaeformis, worm burden is affected parallel to host immune system and climate change. Although immunity prevents any significant long-term net accumulation of T. retortaeformis in the rabbit population, its seasonal effect is to increase heterogeneity in infection and transmission between individuals by worsening the parasite burden in the juveniles exposed to climate warming. Diagnosis
The adult worms live in the small intestine. The diagnosis is based on the observation of eggs in the stool. The eggs are 85–115 um, oval, elongated, and pointed at one or both ends. Trichostrongylus eggs must be differentiated from hookworm eggs, which are smaller and do not have pointed ends. Prevention and treatment
Since the use of herbivore manure as fertilizer is a common practice preceding infection, thorough cleaning and cooking of vegetables is required for prevention of infection. Treatment with pyrantel pamoate is recommended as the first line drug. Alternative agents include mebendazole and albendazole. Successful treatment with ivermectin has also been reported. Another way of avoiding these free-swimming stages of infective larvae, is to wear protective footwear when walking in areas of parasite prominence, and maintain general sanitary practices throughout the day.