What is the treatment for intestinal parasitic worm infestation?

Treatment of Intestinal Parasitic Worm Infestations

The treatment of intestinal parasitic worm infestations depends on the specific type of worm identified, with albendazole being the most effective first-line treatment for most common intestinal worms. 1

Treatment by Worm Type

Roundworms (Ascaris lumbricoides)

• Treatment: Albendazole 400 mg or mebendazole 500 mg as a single dose 1
• Highly effective with cure rates of approximately 98% 2, 3
• Alternative: Ivermectin 200 μg/kg as a single dose 1

Hookworms (Ancylostoma duodenale, Necator americanus)

• Treatment: Albendazole 400 mg daily for 3 days 1
• Cure rates of 96-100% 2, 3
• For severe disease with anemia: Add prednisolone 40-60 mg once daily 1

Whipworms (Trichuris trichiura)

• Treatment: Mebendazole 100 mg twice daily for 3 days combined with ivermectin 200 μg/kg once daily for 3 days 1
• Single-agent therapy has lower efficacy (40-70%) against whipworms 3
• Combination therapy improves cure rates in heavy infections 1

Pinworms/Threadworms (Enterobius vermicularis)

• Treatment: Albendazole 400 mg twice daily for 21 days with monitoring of liver function and full blood count 1
• Alternative: Mebendazole 100 mg or albendazole 400 mg as a single dose 1, 2
• Environmental measures crucial to prevent reinfection:
  • Wash hands and fingernails with soap frequently
  • Wear tight underwear and change daily
  • Clean bedroom floors by vacuuming or damp mopping
  • Wash bed linens and night clothes 2

Tapeworms (Taenia spp.)

• T. solium: Niclosamide 2 g as a single dose 1
• T. saginata: Praziquantel 10 mg/kg as a single dose 1
• Unknown species: Niclosamide 2 g as a single dose 1

Dwarf Tapeworm (Hymenolepis nana)

• Treatment: Praziquantel 25 mg/kg as a single dose 1
• Alternative: Niclosamide 2 g once daily for 7 days 1

Diagnostic Approach

1. Stool examination:

   • Concentrated stool microscopy or fecal PCR 1
   • For pinworms: "Sellotape test" - placing adhesive tape on perianal skin in the morning and examining for eggs 1, 4

2. Additional testing for specific parasites or complications:

   • Serology for certain tissue-invasive parasites
   • Complete blood count to assess for anemia (especially with hookworm)

Special Considerations

Pregnancy and Lactation

• Many antiparasitic medications have limited safety data in pregnancy
• Treatment may be deferred until after first trimester unless urgently needed 1

Immunocompromised Patients

• May require longer treatment courses or combination therapy
• Higher risk of hyperinfection with Strongyloides 1

Children

• Dosage adjustments required based on weight
• Generally well-tolerated with minimal side effects 5, 4

Prevention of Reinfection

• Proper handwashing, especially before eating and after using the toilet
• Wearing shoes in endemic areas
• Avoiding consumption of raw/undercooked meat
• Proper food washing and preparation
• Improved sanitation and waste disposal 1, 2

Monitoring and Follow-up

• Follow-up stool examination 2-3 weeks after treatment completion
• Repeat treatment may be necessary for persistent infections
• Monitor for side effects of medications, particularly with prolonged use (>14 days) 6

Common Pitfalls

• Failure to identify and treat all household members in cases of highly contagious worms (e.g., pinworms)
• Inadequate duration of treatment for certain parasites (e.g., threadworms require longer treatment)
• Not addressing environmental contamination, leading to reinfection
• Overlooking the possibility of mixed infections requiring different treatment approaches 1, 2