What is the recommended treatment for pinworms (Enterobius vermicularis) in children?

Treatment of Pinworms (Enterobius vermicularis) in Children

For pinworm infection in children, a single dose of mebendazole 100 mg or albendazole 400 mg is recommended, with a repeat dose in 2 weeks to ensure complete eradication. 1, 2, 3

First-Line Treatment Options

Medication Options

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

  • FDA-approved for pinworm treatment with 95% cure rate 2
  • Both adulticidal and ovicidal 3

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

  • Effective for most intestinal nematodes including pinworm 1
  • Both adulticidal and ovicidal 3
  • Standard dose for children ≥2 years is 400 mg 1

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

  • FDA-approved alternative, especially for pregnant women 4
  • Only adulticidal (not ovicidal) 3
  • Dosing based on weight (see table below) 4:
    • 25-37 lbs: ½ teaspoonful
    • 38-62 lbs: 1 teaspoonful
    • 63-87 lbs: 1½ teaspoonful
    • 88-112 lbs: 2 teaspoonful
    • 113-137 lbs: 2½ teaspoonful
    • 138-162 lbs: 3 teaspoonful

Special Considerations

Age-Specific Recommendations

• Children <2 years: Consult with specialist before treatment 1, 4
• Children ≥2 years: Standard dosing as above 1

Treatment of Household Members

• All household members should be treated simultaneously, especially with multiple or repeated infections 3
• Family screening is essential as more than 50% of family members may be affected 3

Diagnostic Approach

• Cellophane tape test: Best diagnostic method with 50% sensitivity for a single test, increasing to 90% with three consecutive morning tests 1, 3
• Visual identification of worms in perianal area or stool is diagnostic 3
• Stool examination alone is not recommended as pinworms and eggs are not usually passed in stool 3

Prevention and Control Measures

Hygiene Measures

• Frequent handwashing with soap, especially before eating and after using the toilet 1
• Daily changing of underwear and wearing tight underwear at night 1
• Keeping fingernails short and clean 1
• Avoiding nail-biting and finger-sucking 3

Environmental Measures

• Washing bed linens and night clothes in hot water 1
• Vacuuming or damp mopping bedroom floors 1
• Keeping toilet seats clean 1
• Cleansing hairbrushes and combs with disinfectant 5

Follow-Up and Monitoring

• Repeat treatment in 2 weeks is essential to ensure complete eradication 1, 3
• For recurrent infections, prolonged treatment for up to 16 weeks using a "pulse scheme" may be necessary 6
• No need for laboratory monitoring with short-term treatment 7

Common Pitfalls and Caveats

• Reinfection is common due to the short life span of adult pinworms and autoinfection cycles 3
• Treatment failure often results from inadequate hygiene measures or failure to treat all household members 3
• Albendazole and mebendazole are generally safe for short-term use, but prolonged treatment (>14 days) may require monitoring for hepatotoxicity and leukopenia 1, 7
• Emerging resistance has been documented in some parasites, though less commonly with pinworms 1, 7
• For pregnant women, pyrantel pamoate is preferred over mebendazole and albendazole due to safety concerns 1, 3