What is the treatment for pinworm infection?

Pinworm Treatment

For pinworm infection (enterobiasis), a single dose of mebendazole 100 mg, repeated in two weeks, is the recommended first-line treatment. 1, 2

First-line Treatment Options

• Mebendazole: 100 mg as a single dose, repeated in 2 weeks 1, 2

  • FDA-approved specifically for pinworm (Enterobius vermicularis)
  • Cure rate of approximately 95% 1
  • Both adulticidal and ovicidal activity 2

• Alternative options (if mebendazole unavailable):

  • Albendazole: 400 mg as a single dose, repeated in 2 weeks 3, 2
    • Both adulticidal and ovicidal activity 2
  • Pyrantel pamoate: 11 mg/kg (maximum 1 g) as a single dose, repeated in 2 weeks 3, 2
    • Only adulticidal (not ovicidal) 2
    • Preferred option for pregnant women 3, 2

Special Populations

• Pregnant women: Pyrantel pamoate is preferred over mebendazole and albendazole 3

  • Treatment should be deferred until after first trimester unless benefits outweigh risks

• Children:

  • Children ≥2 years: Same doses as adults (mebendazole 100 mg or albendazole 400 mg) 3
  • Children 12-24 months: Consult specialist before treatment 3
  • Children <12 months: Not recommended for routine deworming 3

Comprehensive Treatment Approach

1. Treat all household members simultaneously 3, 2

   • Essential to prevent reinfection, especially with multiple or repeated infections
   • Reinfection is common due to the short life cycle of pinworms

2. Implement hygiene measures to prevent reinfection:

   • Frequent handwashing with soap, especially before eating and after using the toilet 3
   • Keep fingernails short and clean 3
   • Daily changing of underwear 3
   • Environmental cleaning of living spaces 3
   • Washing bed linens and night clothes in hot water 3
   • Vacuuming or damp mopping bedroom floors 3

3. Follow-up:

   • Clinical follow-up in 2-4 weeks is recommended 3
   • For recurrent infections, consider prolonged treatment for up to 16 weeks using a "pulse scheme" 4

Diagnostic Considerations

• Cellophane tape test is the preferred diagnostic method 3, 2

  • Sensitivity of a single test is around 50%
  • Sensitivity increases to approximately 90% when performed on three consecutive mornings

• 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, 2

Common Pitfalls to Avoid

• Inadequate treatment of household contacts leading to reinfection cycles 3, 2
• Insufficient hygiene measures after treatment 3
• Failure to repeat dose after 2 weeks (needed to kill newly hatched worms) 2
• Overlooking risk factors such as nail-biting, playing on the floor, and inadequate handwashing 3

With proper medication and attention to hygiene measures, pinworm infections can be successfully eradicated in nearly all cases 4.