What are the recommended medications and doses for treating Enterobius vermicularis (OXIURUS) infections?

Treatment of Enterobius vermicularis (Oxiurus) Infection

The recommended first-line treatment for Enterobius vermicularis (pinworm/oxiurus) infection is a single dose of mebendazole 100 mg or albendazole 400 mg, with a repeat dose after 2-3 weeks to prevent reinfection. 1, 2

Medication Options

First-line treatments:

• Mebendazole: 100 mg as a single oral dose 2

  • The tablet may be chewed, swallowed, or crushed and mixed with food
  • Highly effective with cure rates of approximately 95% 2

• Albendazole: 400 mg as a single oral dose 1

  • Equally effective alternative with cure rates of approximately 98% 3
  • Particularly useful in mass treatment programs due to its broad-spectrum activity

Alternative treatment:

• Pyrantel pamoate: Although not mentioned in the most recent guidelines, it remains an effective alternative for those who cannot tolerate benzimidazoles 4

Treatment Protocol

1. Initial treatment: Single dose of mebendazole 100 mg OR albendazole 400 mg
2. Repeat treatment: Administer a second identical dose 2-3 weeks after initial treatment to eliminate newly hatched worms and prevent reinfection 1
3. Family treatment: All household members should be treated simultaneously, even if asymptomatic, to prevent reinfection cycles 4

Special Populations

• Children: The same dosage applies to children and adults for both medications 2
• Pregnant women: Consult with specialist before administering treatment due to potential risks

Additional Management Measures

• Hygiene measures: Essential to prevent reinfection and transmission

  • Hand washing after using the toilet and before meals
  • Daily shower or bath in the morning to remove eggs
  • Regular changing and washing of underwear, bedding, and nightclothes
  • Keep fingernails short and avoid nail-biting and finger-sucking
  • Clean toilet seats and bathroom fixtures regularly

• Environmental measures:

  • Vacuum carpets and damp-dust surfaces to remove eggs
  • Wash all bedding and clothing in hot water to kill eggs

Monitoring and Follow-up

• If symptoms persist 3 weeks after treatment, a second course of treatment is advised 2
• No special procedures such as fasting or purging are required with either medication 2

Clinical Considerations

• Although often asymptomatic, common symptoms include intense perianal pruritus (especially at night), insomnia, restlessness, and irritability 4
• Scratching may lead to secondary bacterial infections of the perianal region 4
• In females, ectopic migration can cause genital tract infections and granulomas 4
• The infection is highly contagious, particularly in settings with crowding such as schools and households 4

Common Pitfalls to Avoid

• Failure to treat all household members simultaneously, which often leads to reinfection cycles
• Neglecting hygiene measures alongside pharmacological treatment
• Not administering the second dose after 2-3 weeks, which is crucial for complete eradication
• Overlooking the possibility of reinfection from environmental sources or untreated contacts

Both mebendazole and albendazole are highly effective treatments with excellent safety profiles, making them appropriate choices for both individual treatment and community-based deworming programs.