From the Guidelines
Mebendazole is best taken as 100 mg twice daily orally. When considering the treatment of whipworm (Trichuris trichiura) infection, the most recent and highest quality study recommends this dosage in combination with ivermectin PO 200 μg/kg once daily for 3 days 1. This combination treatment improves cure rates, especially in heavy infections.
Key Considerations
- The mode of transmission is faeco-oral, so good hygiene practices are essential to prevent reinfection, including thorough handwashing and keeping fingernails short.
- Clinical presentation can be asymptomatic, but heavy infections can cause significant morbidity in children, including anemia, dysentery, rectal prolapse, and impaired growth and cognitive development 1.
- Investigations should include concentrated stool microscopy or faecal PCR to confirm the diagnosis.
Treatment Administration
- The medication should be taken at the same times each day to maintain consistent blood levels.
- It is crucial to complete the full course of treatment even if symptoms improve before finishing.
- Mebendazole works by preventing worms from absorbing nutrients, causing them to die and be expelled from the body.
Special Considerations
- Low cure rates are seen in heavy infection, making combination treatment with ivermectin necessary to improve outcomes 1.
- Family members may need simultaneous treatment as intestinal worms spread easily within households.
- Practice good hygiene, including washing bedding and underwear in hot water, to prevent reinfection.
From the FDA Drug Label
Following administration of 100 mg twice daily for three consecutive days, plasma levels of mebendazole and its primary metabolite, the 2-amine, do not exceed 0.03 mcg/mL and 0.09 mcg/mL, respectively. The FDA drug label does not answer the question.
From the Research
Dosage Information
- The recommended dosage for adults is 100 mg twice daily for 3 days, and for children, 50 mg twice daily for 3 days 2.
- There is no specific information on the best way to take mebendazole, but it is generally taken orally.
Efficacy and Safety
- Mebendazole has been shown to be effective in treating nematode infections, including ascariasis, trichuriasis, and hookworm 2.
- The drug has been found to have a cure rate of 86.8% for Ascaris lumbricoides, 86.0% for Trichuris trichiura, and 85.7% for hookworm 2.
- Mebendazole is generally safe with few side effects, but liver toxicity and other side reactions may occur when used for prolonged periods or in high doses 3.
Combination Therapies
- Combination therapies, such as albendazole plus ivermectin or albendazole plus oxantel pamoate, have been found to be more effective against Trichuris trichiura than mebendazole alone 4, 5.
- The combination of albendazole plus oxantel pamoate has been shown to have the highest efficacy for the treatment of Trichuris trichiura infection 5.
Resistance and Reinfection
- There are emerging issues of drug resistance to mebendazole and other anthelmintic drugs, particularly in hookworms, Trichuris trichiura, and Ascaris lumbricoides 3.
- Reinfection rates with soil-transmitted helminths can be high, highlighting the need for regular anthelminthic treatment in highly endemic settings 4.