What is the recommended treatment for threadworms?

Treatment for Threadworms (Pinworm Infection)

The recommended treatment for threadworms (Enterobius vermicularis) is mebendazole 100 mg as a single dose, repeated in 2 weeks, along with comprehensive hygiene measures for the entire household. 1, 2

First-Line Medication Options

• Mebendazole: 100 mg as a single dose, repeated in 2 weeks (cure rate approximately 95%) 1
• Albendazole: 400 mg as a single dose, repeated in 2 weeks (cure rate approximately 98%) 1
• Pyrantel pamoate: 11 mg/kg (maximum 1 g) as a single dose, repeated in 2 weeks 1, 3

Medication Selection Considerations

• Mebendazole and albendazole are both adulticidal and ovicidal (kill adult worms and eggs) 1, 3
• Pyrantel pamoate is only adulticidal (kills only adult worms) 1, 3
• For pregnant women, pyrantel pamoate is preferred due to its safety profile 1, 3
• Children under 2 years should be evaluated by a specialist before treatment 1

Treatment Protocol

1. Treat all household members simultaneously on the same day to prevent reinfection 1, 4, 3
2. Repeat treatment in 2 weeks to kill newly hatched worms from eggs that survived initial treatment 1, 2
3. Implement strict hygiene measures during treatment period 1, 2, 4

Essential Hygiene Measures

• Hand hygiene: Wash hands and scrub fingernails thoroughly with soap multiple times daily, especially before eating and after using the toilet 1, 2, 4

• Personal hygiene:

  • Keep fingernails short and clean 1, 4
  • Wear tight underwear or pajamas at night to prevent scratching 1, 2, 4
  • Change underwear daily 1
  • Avoid nail-biting and finger-sucking 3

• Environmental cleaning:

  • Wash bed linens and night clothes in hot water daily during treatment 1, 2, 4
  • Vacuum or damp mop bedroom floors (avoid dry sweeping that may stir up dust) 1, 2
  • Keep toilet seats clean 1, 2

Diagnosis

The cellophane tape test is the recommended diagnostic method:

• Single test has approximately 50% sensitivity
• Tests performed on three consecutive mornings increase sensitivity to approximately 90% 1, 3
• Direct visualization of worms in the perianal area is also diagnostic 3

Common Pitfalls and Caveats

1. Failure to treat all household members can lead to reinfection from asymptomatic carriers 1, 3
2. Not repeating treatment after 2 weeks can result in reinfection, as a single dose will not kill eggs 1
3. Neglecting hygiene measures makes treatment ineffective and leads to recurrence 1
4. Inadequate follow-up such as not repeating diagnostic testing 2-3 weeks after treatment completion can lead to persistent symptoms 1
5. Not recognizing the high contagiousness of pinworms - even the cleanest and most careful people can get them 2

Threadworm infections are common, especially among children, but with proper medication and hygiene measures, they can be effectively treated with cure rates exceeding 95% 1, 3.