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

Standard De-worming Protocol for Intestinal Worm Infections

The standard first-line treatment for most intestinal helminths is albendazole 400 mg as a single dose, with mebendazole 500 mg as a single dose being an alternative option, while ivermectin 200 μg/kg daily for 1-2 days is the first-line treatment specifically for strongyloidiasis. 1

Diagnosis Before Treatment

• Diagnostic methods:
  • Concentrated stool microscopy for ova and parasites (2-3 samples for increased sensitivity)
  • Perianal swab or adhesive tape test for pinworms (50% sensitivity for single test, 90% when performed on three consecutive mornings)
  • Visual identification of worms in perianal area or stool is diagnostic
  • Note: Stool examination alone is not recommended for pinworms as eggs are not usually passed in stool 1

Treatment Protocols by Parasite Type

General Intestinal Helminths

• First-line: Albendazole 400 mg as a single dose 1
• Alternative: Mebendazole 500 mg as a single dose 1
• Other options:
  • Mebendazole 100 mg twice a day for 3 days 1
  • Mebendazole 100 mg twice a day combined with ivermectin 200 μg/kg once a day for 3 days 1

Strongyloidiasis

• First-line: Ivermectin 200 μg/kg daily for 1-2 days 1
• Extended treatment: Required for hyperinfection syndrome 1
• Follow-up: At least three stool examinations over three months following treatment 1, 2
• Note: Ivermectin has shown superior efficacy (96.8% cure rate) compared to albendazole (63.3% cure rate) for strongyloidiasis 3

Neurocysticercosis

• First-line: Praziquantel 10 mg/kg as a single dose 1
• Important: Expert advice is essential for specific treatment protocols 1

Empirical Treatment

• For suspected parasitic infection without specific diagnosis, especially in patients with eosinophilia:
  • Albendazole 400 mg in a single dose plus ivermectin 200 μg/kg in a single dose 1

Special Populations

Children

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

Pregnant Women

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

Prevention and Control Measures

• Critical hygiene measures:

  • Frequent handwashing with soap, especially before eating and after using toilet 1, 4
  • Daily changing of underwear and wearing tight underwear at night 1, 4
  • Keeping fingernails short and clean 1
  • Environmental cleaning (washing bed linens in hot water, vacuuming/damp mopping floors) 1, 4

• Household management:

  • Treat all household members simultaneously, especially with pinworm infections 1
  • Family screening is essential as >50% of family members may be affected 1

Follow-up and Monitoring

• General follow-up: Clinical follow-up in 2-4 weeks for most intestinal helminths 1
• Strongyloidiasis: At least three stool examinations over three months 1, 2
• Treatment failure: Consider repeat stool examination and alternative treatment for persistent symptoms 1

Important Considerations and Pitfalls

• Drug efficacy limitations:

  • Albendazole has reduced efficacy against Trichuris trichiura (48% cure rate) and Strongyloides stercoralis (62% cure rate) 1
  • Single-dose albendazole may not be effective for Ascaris lumbricoides infections, with infection rates returning to baseline by 12-16 weeks post-treatment 5

• Emerging resistance:

  • Documented in hookworms, T. trichiura, possibly A. lumbricoides, W. bancrofti, and Giardia species 1
  • May necessitate alternative or combination therapy 1

• Medication safety:

  • Albendazole is generally safe for short-term use 1
  • 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
  • Ivermectin works by binding to glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing paralysis and death of the parasite 2

• Timing considerations:

  • Complete antiparasitic treatment at least 1 week before starting immunosuppressive therapy 1