From the FDA Drug Label
Mebendazole tablets are indicated for the treatment of Enterobius vermicularis (pinworm), Trichuris trichiura (whipworm), Ascaris lumbricoides (common roundworm), Ancylostoma duodenale (common hookworm), Necator americanus (American hookworm) in single or mixed infections. When one individual in a household has pinworms, the entire household should be treated unless otherwise advised.
The recommended treatment for asymptomatic patients with enterobiasis (pinworm infection) is not directly addressed in the provided drug labels. However, it can be inferred that treatment may be considered for asymptomatic individuals, especially if they are part of a household where someone has been diagnosed with pinworms, as stated in the pyrantel pamoate label 1.
- Treatment may be recommended for asymptomatic patients to prevent the spread of infection, especially in household settings.
- The decision to treat asymptomatic patients should be made on a case-by-case basis, considering factors such as the risk of transmission and the potential benefits and risks of treatment. However, no explicit recommendation for asymptomatic patients can be drawn from the provided labels 2 and 1.
From the Research
For asymptomatic patients with enterobiasis (pinworm infection), treatment is still recommended to prevent transmission to others. The first-line treatment is a single dose of pyrantel pamoate (11 mg/kg, maximum 1 gram) or a single dose of albendazole (400 mg for adults and children over 2 years; 200 mg for children 1-2 years) 3. Mebendazole (100 mg once) is another effective option. Treatment should be repeated after two weeks to kill any newly hatched worms, as the medications do not kill eggs. All household members should be treated simultaneously to prevent reinfection, even if they are asymptomatic. Additionally, environmental control measures are important:
- washing bedding and underwear in hot water,
- daily showering (especially in the morning to remove eggs),
- keeping fingernails short,
- avoiding nail-biting, and
- thorough handwashing. These measures are necessary because pinworms have a self-reinfection cycle where eggs can survive on surfaces for up to three weeks, and the female worms lay eggs around the anus at night, causing itching that leads to contaminated hands and continued transmission 3. Given their safety and effectiveness, mebendazole and albendazole are currently the best available drugs for the treatment of pinworm infestation 3. It's also important to note that for pregnant women, pyrantel is preferred to mebendazole and albendazole 3. The most recent and highest quality study supports the use of these treatments, and prioritizing the treatment of asymptomatic patients is crucial in preventing the spread of the infection and reducing the risk of morbidity and mortality 3.