What is the standard de-worming protocol for treating intestinal worm infections?

Standard De-worming Protocols for Intestinal Worm Infections

For most common intestinal worm infections, a single dose of albendazole 400 mg or mebendazole 100 mg is the standard first-line treatment, with specific dosing regimens required for certain parasites. 1

Diagnostic Approach

Before initiating treatment, proper diagnosis is essential:

• Pinworms (Enterobius vermicularis):

  • Cellophane tape test (sellotape test) performed on 3 consecutive mornings (90% sensitivity) 1
  • Visual identification of worms in perianal area (especially at night)
  • Note: Stool examination alone is not recommended as pinworms are rarely detected in stool 1

• Other intestinal helminths:

  • Concentrated stool microscopy for ova and parasites 2
  • Multiple stool samples may be needed (at least 2-3) for increased sensitivity
  • Perianal swab or perianal adhesive tape test for pinworms 2
  • Laboratory identification of larvae or adult worms when possible 2

Treatment Protocols by Parasite Type

1. Common Roundworms (Ascaris lumbricoides)

• First-line: Albendazole 400 mg as a single dose 2, 1
• Alternative: Mebendazole 100 mg twice daily for 3 days 1

2. Pinworms (Enterobius vermicularis)

• First-line: Albendazole 400 mg or mebendazole 100 mg as a single dose 1
• Important: Repeat dose in 2 weeks to ensure complete eradication 1
• For pregnant women: Pyrantel pamoate (safer in pregnancy) 1

3. Hookworms (Ancylostoma duodenale, Necator americanus)

• First-line: Albendazole 400 mg as a single dose 2, 1
• Alternative: Mebendazole 500 mg as a single dose 2

4. Whipworm (Trichuris trichiura)

• First-line: Albendazole 400 mg as a single dose 2
• Note: Lower efficacy (48% cure rate) may require repeated dosing 1, 3

5. Strongyloidiasis (Strongyloides stercoralis)

• First-line: Ivermectin 200 μg/kg daily for 1-2 days 2, 4
• Alternative: Albendazole 400 mg twice daily for 7 days (less effective) 4
• For hyperinfection syndrome: Extended treatment required; seek specialist advice 2

6. Tapeworms (Taenia species)

• First-line: Praziquantel 10 mg/kg as a single dose 2
• For neurocysticercosis: Expert advice essential; requires specific treatment protocols 2

Special Populations

Children

• Children ≥2 years: Same doses as adults (albendazole 400 mg or mebendazole 100 mg) 1
• Children 12-24 months: Discuss with specialist before treatment 2
• Children <12 months: Not recommended for routine deworming 2

Pregnant Women

• Avoid albendazole and mebendazole if possible
• Preferred: Pyrantel pamoate for pinworm infections 1
• Defer treatment until after first trimester unless benefits outweigh risks

Immunocompromised Patients

• Complete antiparasitic treatment at least 1 week before starting immunosuppressive therapy 1
• For strongyloidiasis in immunocompromised patients: Extended ivermectin treatment (200 μg/kg on days 1,2,15, and 16) 2
• Seek specialist advice for complicated cases 2

Empirical Treatment

For suspected parasitic infection without specific diagnosis, especially in returning travelers with eosinophilia:

• Standard empirical regimen: Albendazole 400 mg plus ivermectin 200 μg/kg as single doses 2, 1
• Consider repeating treatment after 2 weeks 2
• For persistent eosinophilia, further investigation and specialist consultation is warranted 2

Prevention of Reinfection

Critical hygiene measures to prevent reinfection include:

• Frequent handwashing with soap, especially before eating and after using the toilet 1, 5
• Daily changing of underwear and wearing tight underwear at night 1, 5
• Keeping fingernails short and clean 1, 5
• Environmental cleaning:
  • Washing bed linens and night clothes in hot water
  • Vacuuming or damp mopping bedroom floors
  • Keeping toilet seats clean 1, 5
• Treatment of all household members simultaneously, especially with pinworm infections 1

Follow-up

• For most intestinal helminths: Clinical follow-up in 2-4 weeks
• For strongyloidiasis: At least three stool examinations over three months following treatment 6
• For persistent symptoms or suspected treatment failure: Repeat stool examination and consider alternative treatment

Common Pitfalls

1. Inadequate diagnosis: Relying on a single stool sample can miss infections; multiple samples increase sensitivity
2. Incomplete household treatment: Failing to treat all household members simultaneously can lead to reinfection
3. Insufficient hygiene measures: Not implementing proper hygiene measures after treatment often leads to reinfection
4. Inappropriate drug selection: Using albendazole for strongyloidiasis when ivermectin is more effective 4
5. Inadequate follow-up: Especially for strongyloidiasis, which can persist despite treatment 6
6. Emerging resistance: Reduced efficacy has been documented in hookworms and other parasites, requiring vigilance and potentially alternative treatments 1

By following these evidence-based protocols and addressing common pitfalls, most intestinal worm infections can be effectively treated and prevented.