What is the treatment for threadworm symptoms?

From the Guidelines

The most effective treatment for threadworm symptoms is a single dose of albendazole 400 mg, mebendazole 500 mg, or ivermectin 200 μg/kg, as recommended by the latest guidelines. When considering treatment options, it's essential to prioritize the most recent and highest quality studies, such as the 2025 UK guidelines for the investigation and management of eosinophilia in returning travellers and migrants 1. Key points to consider in the treatment of threadworm symptoms include:

• The prepatent period of 2-3 months, during which the infection may be asymptomatic 1
• The mode of transmission, which is primarily through the faeco-oral route 1
• The clinical presentation, which can range from asymptomatic to abdominal pain, diarrhea, and gastrointestinal obstruction in severe cases 1
• The importance of investigations, such as concentrated stool microscopy or faecal PCR, to confirm the diagnosis 1
• The recommended treatment options, including albendazole, mebendazole, or ivermectin, as a single dose 1 It's crucial to note that while these medications are effective in killing the adult worms, they may not affect the eggs, which can lead to reinfection. Therefore, proper hygiene measures, such as frequent handwashing, keeping fingernails short, and changing and washing bedding and underwear daily in hot water, are essential to prevent reinfection. In real-life clinical practice, it's also important to consider the potential for reinfection and the need for simultaneous treatment of all household members, even if they don't have symptoms, to prevent the spread of the infection.

From the FDA Drug Label

Indications For the treatment of pinworms. INDICATIONS AND USAGE Mebendazole tablets are indicated for the treatment of Enterobius vermicularis (pinworm), The treatment for threadworm symptoms is pyrantel pamoate (PO) or mebendazole (PO).

• The dosage for pyrantel pamoate (PO) is a single dose of 5 milligrams of pyrantel base per pound, or 11 milligrams per kilogram, of body weight not to exceed 1 gram 2.
• Mebendazole (PO) is also effective in treating threadworms, with a cure rate of 95% 3.

From the Research

Threadworm Symptoms and Treatment

• Threadworms are common parasites that live in the intestine and migrate to the anus, sometimes causing an itchy bottom 4, 5.
• The most common presenting symptom of threadworm infestation is nocturnal pruritus ani, although approximately 30 to 40% of infested patients do not show any clinical symptoms of the disease 4.
• The diagnosis of threadworm infection is best established by the cellophane tape test, with a sensitivity of around 50% for a single test and approximately 90% with tests performed on three different mornings 4.

Treatment Options

• The drugs of choice for the treatment of threadworm infestation are mebendazole (100 mg), pyrantel pamoate (11 mg/kg, maximum 1 g), and albendazole (400 mg), all of which are given in a single dose and repeated in two weeks 4.
• Mebendazole and albendazole are both adulticidal and ovicidal, whereas pyrantel pamoate is only adulticidal 4.
• For pregnant women, pyrantel is preferred to mebendazole and albendazole 4.
• Treatment of all household members should be considered, especially if there are multiple or repeated symptomatic infections, as reinfection is common even when effective medication is given 4, 5, 6.

Prevention and Hygiene Measures

• Good personal hygiene, such as frequent handwashing, especially after bowel movements and before meals, clipping of fingernails, avoidance of finger-sucking, nail-biting, and scratching in the anogenital area, are important preventive measures 4, 5, 6.
• Washing underwear and night-wear daily to destroy the eggs and wearing pyjamas or pants at night to help prevent fingers scratching the anal area can also help prevent reinfection 5.