What is the recommended treatment for pinworms?

Treatment of Pinworms (Enterobius vermicularis)

The recommended first-line treatment for pinworm infection is a single dose of mebendazole 100 mg or albendazole 400 mg, repeated in 2 weeks, with cure rates of approximately 95%. 1, 2, 3

Medication Options

First-line treatments:

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

  • Both adulticidal and ovicidal
  • FDA-approved with 95% cure rate
  • Safe for children over 2 years

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

  • Both adulticidal and ovicidal
  • FDA-approved
  • Safe for children over 2 years

• Pyrantel pamoate: 11 mg/kg (maximum 1 g) as a single dose, repeated in 2 weeks 4, 3

  • Only adulticidal (not ovicidal)
  • Dosed by weight: 5 mg per pound of body weight
  • Preferred option for pregnant women
  • Can be taken with or without food

Treatment Protocol

1. Initial treatment: Administer single dose of chosen medication
2. Repeat treatment: Give second dose 2 weeks after initial treatment to kill newly hatched worms
3. Treat household members: Consider treating all household members simultaneously, especially with multiple or repeated infections 3

Hygiene Measures (Essential for Treatment Success)

• Frequent handwashing, especially after using the bathroom and before eating
• Keep fingernails short and clean
• Change and wash underwear, bedding, and pajamas daily during treatment
• Avoid nail-biting and finger-sucking
• Clean toilet seats and bathroom surfaces regularly

Special Populations

• Pregnant women: Pyrantel pamoate is preferred over mebendazole and albendazole 3
• Children under 2 years: Consult with a pediatrician before treatment 4

Common Pitfalls and Caveats

1. Failure to repeat treatment: The second dose after 2 weeks is crucial as the initial treatment may not kill eggs, which can hatch and cause reinfection
2. Neglecting household treatment: Treating only the infected individual often leads to reinfection from untreated family members
3. Inadequate hygiene measures: Medications alone without improved hygiene practices will likely result in treatment failure
4. Misdiagnosis: The cellophane tape test has only about 50% sensitivity with a single test; three tests on consecutive mornings increases sensitivity to 90% 3
5. Expecting immediate symptom relief: Pruritus ani may persist for several days after treatment despite parasite elimination

Remember that pinworm infections, while uncomfortable, are generally not dangerous and can be effectively treated with the appropriate medication and hygiene measures.