What is the recommended treatment for pinworms (Enterobius vermicularis) in a 32-month-old male?

Treatment for Pinworms in a 32-Month-Old Male

For pinworm (Enterobius vermicularis) infection in a 32-month-old male, mebendazole 100 mg as a single dose, repeated in 2 weeks, is the recommended treatment. 1

First-Line Treatment Options

The American Academy of Pediatrics recommends the following options for treating pinworm infections in children:

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

Since the patient is 32 months old (over 2 years), all these options are appropriate according to guidelines 1.

Medication Selection Considerations

• Mebendazole is FDA-approved specifically for pinworm treatment and can be chewed, swallowed, or crushed and mixed with food 2
• Both mebendazole and albendazole are adulticidal (kill adult worms) and ovicidal (kill eggs) 3
• Pyrantel pamoate is only adulticidal (not ovicidal) 3
• No special procedures such as fasting or purging are required with mebendazole 2

Important Treatment Principles

1. Repeat treatment after 2 weeks is essential as a single dose will not kill eggs that may hatch after initial treatment 1, 3

2. Treat all household members simultaneously to prevent reinfection from asymptomatic carriers 1, 3

3. Implement hygiene measures alongside medication:

   • Frequent handwashing with soap, especially before eating and after using the toilet
   • Daily changing of underwear
   • Keeping fingernails short and clean
   • Washing bed linens and night clothes in hot water
   • Vacuuming or damp mopping bedroom floors 1

Follow-up and Monitoring

• Consider diagnostic testing 2-3 weeks after treatment completion to ensure eradication 1
• The cellophane tape test has approximately 50% sensitivity for a single test and 90% for tests performed on three consecutive mornings 1, 3
• If symptoms persist after treatment, consider repeating the treatment course or investigating for other parasitic infections 3

Common Pitfalls to Avoid

1. Inadequate follow-up: Not repeating treatment after 2 weeks can lead to reinfection 1
2. Neglecting hygiene measures: Treatment without improved hygiene is often ineffective 1
3. Treating only the symptomatic individual: Failing to treat all household members can lead to reinfection 1, 3
4. Misdiagnosis: Other parasitic infections can mimic pinworm symptoms 4

Remember that pinworm infection is transmitted primarily through the fecal-oral route, with eggs transferred from the anus to the mouth through contaminated hands. Proper hygiene practices are essential for preventing reinfection 1, 3.