What is the recommended treatment for Ascaris lumbricoides infection?

Treatment of Ascaris lumbricoides Infection

For Ascaris lumbricoides infection, a single dose of albendazole 400 mg, mebendazole 500 mg, or ivermectin 200 μg/kg is recommended as first-line treatment. 1

First-Line Treatment Options

All three medications are highly effective against Ascaris lumbricoides with similar cure rates:

• Albendazole: 400 mg as a single oral dose
• Mebendazole: 500 mg as a single oral dose
• Ivermectin: 200 μg/kg as a single oral dose

These medications have demonstrated high efficacy with cure rates of:

• Albendazole: 93-98% 2
• Mebendazole: 95-97% 2, 3
• Ivermectin: 87-90% 2

Clinical Considerations

Efficacy

• High-quality evidence shows that all three medications provide excellent parasitological cure rates for Ascaris infection 2
• The egg reduction rate is extremely high (96-100%) regardless of which anthelmintic is used 2
• Single-dose therapy is as effective as multiple doses for Ascaris treatment 2

Special Populations

• For children: All three medications are safe and effective, with dosing adjusted by weight for ivermectin
• For pregnant women: Treatment is generally deferred until after delivery unless urgently needed

Comorbid Helminth Infections

If the patient has concurrent helminth infections:

• Hookworm co-infection: Albendazole or mebendazole is preferred (ivermectin is ineffective against hookworm) 4
• Strongyloides co-infection: Ivermectin would be preferred (83% cure rate vs. 45% for albendazole) 4
• Trichuris co-infection: Mebendazole may be more effective (34.7% cure rate vs. 13.9% for albendazole) 3

Monitoring and Follow-up

• Clinical improvement should be seen within days of treatment
• Stool examination 2-4 weeks after treatment can confirm parasitological cure
• In areas of high reinfection risk, periodic retreatment may be necessary

Common Pitfalls

1. Failure to treat household contacts: Consider treating all household members to prevent reinfection
2. Inadequate sanitation education: Treatment without addressing hygiene and sanitation will lead to reinfection
3. Overlooking nutritional status: Heavy Ascaris infections can cause malnutrition that may need addressing
4. Missing mixed infections: Always consider the possibility of mixed helminth infections that may require different treatment approaches

Side Effects

Side effects are generally mild and transient with all three medications:

• Most common: nausea, vomiting, abdominal pain, diarrhea, headache, and fever
• Serious adverse events are rare with all three medications 2

In conclusion, single-dose therapy with any of the three recommended medications (albendazole, mebendazole, or ivermectin) is highly effective for treating Ascaris lumbricoides infection, with the choice potentially influenced by concurrent helminth infections and local drug availability.