What is the recommended treatment for enterobiasis (infection with pinworms)?

Treatment of Enterobiasis (Pinworm Infection)

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

Recommended Medications

First-Line Options:

• Mebendazole: 100 mg as a single dose, repeated in 2 weeks 1, 2
• Albendazole: 400 mg as a single dose, repeated in 2 weeks 1, 3
• Pyrantel pamoate: 11 mg/kg (maximum 1 g) as a single dose, repeated in 2 weeks 3

Medication Characteristics:

• Mebendazole and albendazole are both adulticidal and ovicidal (kill adult worms and eggs) 1, 3
• Pyrantel pamoate is only adulticidal (kills adult worms but not eggs) 1, 3
• For pregnant women, pyrantel pamoate is preferred over mebendazole and albendazole due to safety concerns 3

Treatment Algorithm

1. Diagnosis confirmation: Cellophane tape test (performed in the morning before bathing) is the preferred diagnostic method 3

   • Single test sensitivity: ~50%
   • Three tests on different mornings: ~90% sensitivity

2. Initial treatment:

   • Administer mebendazole 100 mg as a single dose 1, 2
   • Alternative: albendazole 400 mg as a single dose 1, 3

3. Follow-up treatment:

   • Repeat the same dose after 2 weeks to kill newly hatched worms 1, 2, 3

4. Household management:

   • Treat all household members simultaneously, especially with multiple or repeated infections 3
   • This reduces the risk of reinfection from asymptomatic carriers

5. For persistent/recurrent infections:

   • Consider extended "pulse therapy" for up to 16 weeks in cases of recurrent infection 4

Adjunctive Measures

Implement strict hygiene practices during treatment period:

• Frequent handwashing, especially after using the toilet and before eating 1, 3
• Regular changing and washing of underwear, bedding, and pajamas 1
• Keep fingernails short and clean 1, 3
• Avoid finger-sucking, nail-biting, and scratching in the perianal area 3
• Daily morning showers to remove eggs deposited overnight 3

Clinical Considerations

• Enterobiasis affects approximately 30% of children worldwide and up to 60% in some developing countries 3
• The infection is most common in children aged 5-14 years 3
• About 30-40% of infected individuals are asymptomatic 3
• The most common symptom is nocturnal perianal pruritus (itching) 3
• Reinfection is common due to the short life cycle of pinworms and autoinfection 3

Special Populations

• Children: Same dosage as adults for all recommended medications 2
• Pregnant women: Pyrantel pamoate is preferred 3
• Immunocompromised: Standard treatment regimen applies

Treatment Efficacy

Mebendazole has demonstrated a 95% cure rate for pinworm infections when properly administered with the two-dose regimen 1, 2

Despite effective medication, recurrences are common due to reinfection cycles, particularly autoinfection. This highlights the importance of hygiene measures and treating all household members simultaneously 3.