What is the treatment for enterobiasis (pinworms)?

Treatment for Enterobiasis (Pinworms)

The first-line treatment for pinworm infection is a single dose of mebendazole 100 mg, repeated in 2 weeks, which has a cure rate of approximately 95%. 1, 2

Medication Options

First-line treatments:

• Mebendazole: 100 mg as a single dose, repeated in 2 weeks 1, 2

  • FDA-approved for pinworm treatment
  • Both adulticidal and ovicidal
  • Can be chewed, swallowed, or crushed and mixed with food

• Albendazole: 400 mg as a single dose, repeated in 2 weeks 1, 3

  • FDA-approved alternative
  • Both adulticidal and ovicidal
  • Similar efficacy to mebendazole

• Pyrantel pamoate: 11 mg/kg (maximum 1 g) as a single dose, repeated in 2 weeks 3

  • Only adulticidal (not ovicidal)
  • Preferred option for pregnant women 3

Treatment Algorithm

1. Initial treatment: Single dose of mebendazole 100 mg or albendazole 400 mg
2. Repeat treatment: Same dose 2 weeks after initial treatment
3. Treatment failure: If not cured 3 weeks after treatment, administer a second course 2
4. Household treatment: Consider treating all household members simultaneously, especially with multiple or repeated infections 3

Hygiene Measures (Critical for Treatment Success)

Implement these measures during the treatment period:

• Frequent handwashing, especially after using the toilet and before eating
• Regular changing and washing of underwear, bedding, and pajamas
• Keeping fingernails short and clean
• Daily shower or bath in the morning to remove eggs deposited overnight
• Avoid scratching the perianal area

Special Populations

• Pregnant women: Pyrantel pamoate is preferred over mebendazole and albendazole 3
• Children: Same dosage as adults for all medications 2
• Recurrent infections: Consider extended treatment protocols and ensure all household members are treated simultaneously 4

Monitoring and Follow-up

• No special procedures such as fasting or purging are required 2
• Consider repeating the cellophane tape test 2-3 weeks after completing treatment to confirm cure
• The sensitivity of a single cellophane tape test is around 50%, but increases to approximately 90% with tests performed on three different mornings 3

Common Pitfalls

1. Failure to treat all household members - Reinfection is common when only the symptomatic individual is treated
2. Inadequate hygiene measures - Treatment will likely fail without concurrent implementation of strict hygiene practices
3. Missing the second dose - The two-week follow-up dose is essential for complete eradication
4. Relying on stool examination - Pinworms and eggs are not usually passed in stool; the cellophane tape test is the preferred diagnostic method 3
5. Overlooking risk factors - Playing on the floor, nail biting, and inadequate handwashing are significant risk factors that need to be addressed 1

With proper medication and hygiene measures, pinworm infections can be effectively treated with minimal complications and a high cure rate.