What is the recommended treatment for pinworms?

Treatment for Pinworms

The first-line treatment for pinworm infection is albendazole 400 mg or mebendazole 100 mg as a single dose, repeated in two weeks, with treatment of all household members simultaneously to prevent reinfection. 1

Medication Options

First-Line Treatments

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

  • Both adulticidal and ovicidal
  • FDA-approved with 95% cure rate for pinworms 2

• Albendazole: 400 mg as a single dose, repeated in 2 weeks 1, 3

  • Both adulticidal and ovicidal
  • Equally effective as mebendazole

Alternative Options

• Pyrantel pamoate: 11 mg/kg (maximum 1 g) as a single dose, repeated in 2 weeks 1, 4, 3

  • Only adulticidal (not ovicidal)
  • Preferred option for pregnant women 1, 3

• Ivermectin: 200 μg/kg as a single dose 1

  • Effective alternative when first-line treatments fail or are contraindicated
  • May be particularly useful for resistant cases 5

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 1
• Children <12 months: Not recommended for routine deworming 1

Pregnant Women

• Pyrantel pamoate is preferred over albendazole and mebendazole 1, 3
• Treatment should be deferred until after the first trimester unless benefits outweigh risks 1

Treatment Protocol

1. Initial treatment: Single dose of chosen medication
2. Repeat treatment: Second dose 2 weeks after initial treatment to kill newly hatched worms
3. Treat all household members simultaneously to prevent reinfection 1, 3, 6
4. For recurrent infections: Consider prolonged treatment for up to 16 weeks using a "pulse scheme" 6

Prevention of Reinfection

• Hand hygiene: Frequent handwashing with soap, especially after using the toilet and before eating 1
• Personal hygiene:
  • Keep fingernails short and clean
  • Daily changing of underwear
  • Avoid scratching perianal area
  • Avoid nail-biting and finger-sucking 1, 3
• Environmental cleaning: Regular cleaning of living spaces, especially bedding 1

Diagnosis

The gold standard for diagnosing pinworm infection is the cellophane tape test:

• 50% sensitivity for a single test
• Increases to approximately 90% when performed on three consecutive mornings 1
• Best performed in the morning before bathing or defecation

Common Pitfalls to Avoid

1. Failure to treat all household members simultaneously - this is essential to prevent reinfection cycles 1, 3
2. Inadequate hygiene measures - without proper hygiene, medication alone may not prevent reinfection 1
3. Single treatment only - the two-week follow-up dose is crucial to eliminate newly hatched worms 3
4. Overlooking female genital tract colonization - pinworms can cause vaginal discharge and should be considered in persistent cases 5
5. Ignoring risk factors - playing on the floor (OR 2.5), nail biting (OR 2.1), and failure to wash hands before meals (OR 1.7) are significant risk factors 1

Pinworm infection, while not usually dangerous, is highly contagious and can cause significant discomfort. With proper medication and hygiene measures, it can be effectively treated and prevented from recurring.