What is the recommended treatment for enterobiasis (pinworm infection) in a 10-year-old child?

Treatment of Enterobiasis (Pinworm Infection) in a 10-Year-Old Child

The recommended first-line treatment for enterobiasis (pinworm infection) in a 10-year-old child is a single dose of mebendazole 100 mg, repeated after 2 weeks to eliminate newly hatched parasites. 1

Medication Options

First-Line Treatment

• Mebendazole: 100 mg as a single dose, repeated after 2 weeks 1, 2
  • FDA-approved specifically for pinworm infections
  • Both adulticidal and ovicidal
  • Available in chewable tablet form that can be swallowed whole, chewed, or crushed and mixed with food 1
  • Cure rate of approximately 95% 1

Alternative Options

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

  • Both adulticidal and ovicidal
  • Similar efficacy to mebendazole
  • May have fewer side effects than mebendazole in some cases

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

  • Only adulticidal (not ovicidal)
  • Preferred in pregnancy when treatment is necessary

Treatment Considerations

Why Two Doses Are Necessary

The two-dose regimen (initial dose and repeat after 2 weeks) is critical because:

• The medication kills adult worms but may not kill all eggs
• The pinworm life cycle is approximately 2-6 weeks 2
• Reinfection is common due to the high infectivity of eggs and autoinfection 3

Household Management

• Treat all household members simultaneously 3, 4
  • Essential for preventing reinfection
  • Particularly important when there are multiple or repeated infections
  • Household members may be asymptomatic carriers

Hygiene Measures

To prevent reinfection during and after treatment:

• Frequent handwashing, especially after using the toilet and before eating
• Regular cleaning of the perianal area
• Daily changing and washing of underwear, pajamas, and bed linens
• Keeping fingernails short and discouraging nail-biting
• Avoiding scratching the perianal area

Monitoring and Follow-up

• Clinical improvement typically occurs within days of treatment
• If symptoms persist beyond 3 weeks after completing the two-dose regimen, consider:
  • Reinfection from untreated household contacts
  • Treatment failure (rare)
  • Alternative diagnosis

Special Considerations

Recurrent Infections

For recurrent infections despite appropriate treatment:

• Consider longer treatment courses (up to 16 weeks using a "pulse scheme") 4
• Reinforce hygiene measures
• Ensure all household contacts are treated simultaneously
• Consider potential reservoirs, including rare cases of vaginal enterobiasis 5

Complications

While enterobiasis is generally benign, be aware of potential complications:

• Vulvovaginitis in females 2, 5
• Rare cases of appendicitis-like symptoms 6
• Psychological distress from persistent symptoms 4

By following this treatment approach with proper medication dosing and attention to household-wide treatment and hygiene measures, enterobiasis can be effectively managed in pediatric patients.