What is the treatment for intestinal worms?

Treatment for Intestinal Worms

Albendazole 400 mg as a single dose is the first-line treatment for most intestinal worm infections, with specific regimens required for certain parasites. 1

First-Line Treatment Options

Standard Treatment Regimens

• Albendazole 400 mg single dose:

  • First-line for most intestinal nematodes including hookworm, Ascaris, and pinworm 2, 1
  • Highly effective with cure rates of 95-98% for Ascaris lumbricoides, Ancylostoma duodenale, and Enterobius vermicularis 3
  • Standard dose for children ≥2 years 1

• Mebendazole alternatives:

  • 100 mg twice daily for 3 days 4
  • 100 mg as a single dose for pinworm 1, 5
  • Particularly effective for Ascaris (100% cure rate) and Trichuris (94% cure rate) 4

Special Populations

• Pregnant women: Pyrantel pamoate is preferred over albendazole or mebendazole due to safety profile 1
• Children: Albendazole 400 mg single dose for children ≥2 years 1

Treatment by Parasite Type

Pinworm (Enterobius vermicularis)

• Albendazole 400 mg or mebendazole 100 mg as single dose 2, 1
• Repeat dose after 2 weeks to ensure complete eradication 1
• All household members should be treated simultaneously, especially with multiple or repeated infections 1

Roundworm (Ascaris lumbricoides)

• Albendazole 400 mg single dose (98% cure rate) 2, 5
• Mebendazole 100 mg twice daily for 3 days (100% cure rate) 4

Hookworm (Ancylostoma duodenale/Necator americanus)

• Albendazole 400 mg single dose (96% cure rate) 2, 5
• Mebendazole 100 mg twice daily for 3 days (82% cure rate) 4

Whipworm (Trichuris trichiura)

• Albendazole 400 mg single dose (68% cure rate) 2, 5
• Mebendazole 100 mg twice daily for 3 days (94% cure rate) 4

Tapeworm (Taenia species)

• Praziquantel 10 mg/kg as a single dose 2

Dwarf Tapeworm (Hymenolepis nana)

• Praziquantel 25 mg/kg as a single dose 2

Strongyloidiasis (Strongyloides stercoralis)

• Albendazole 400 mg twice daily for 3-7 days 1
• Ivermectin 200 μg/kg in a single dose is an effective alternative 1

Diagnosis

• Pinworm: Cellophane tape test (50% sensitivity for single test, 90% for three consecutive mornings) 1
• Other worms: Concentrated stool microscopy 2
• Visual identification: Worms in perianal area or stool is diagnostic 1

Prevention and Follow-up

Prevention 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
• Environmental cleaning: washing bed linens in hot water, vacuuming bedroom floors 1

Follow-up

• Repeat dose after 2 weeks for pinworm infections 1
• Family screening is essential as more than 50% of family members may be affected 1

Important Considerations

Emerging Resistance

• Reduced efficacy against certain parasites: Trichuris trichiura (48% cure rate) and Strongyloides stercoralis (62% cure rate) 1
• Emerging resistance documented in hookworms, T. trichiura, possibly A. lumbricoides 1, 6

Safety Profile

• Albendazole and mebendazole are generally safe with few side effects for short-term use 6
• Treatment courses >14 days require monitoring for hepatotoxicity (elevated liver enzymes in up to 16% of cases) and leukopenia (up to 10% of patients) 1, 6
• Neutropenia due to myelosuppression is a potential risk with high doses for prolonged periods 1, 6

Quality Concerns

• Storage conditions, climate, and distribution routes can affect medicine quality 7
• Some commercially available products may have poor dissolution profiles, potentially affecting efficacy 7