What is the recommended treatment for roundworm infections?

Treatment of Roundworm Infections

For roundworm (Ascaris lumbricoides) infections, albendazole 400 mg as a single dose is the recommended first-line treatment, with mebendazole 100 mg twice daily for 3 consecutive days as an effective alternative. 1, 2

First-Line Treatment Options

Albendazole

• Dosage: 400 mg as a single dose
• Efficacy: 100% cure rate for Ascaris lumbricoides 3
• Advantages: Convenient single-dose administration
• Patient population: Adults and children ≥2 years receive the same dose 1

Mebendazole

• Dosage: 100 mg twice daily (morning and evening) for 3 consecutive days 2
• Efficacy: 98% cure rate for common roundworm (Ascaris lumbricoides) 2
• Patient population: Same dosage for adults and children 2

Special Populations

Children

• Children ≥2 years: Same doses as adults
• Children 12-24 months: Consult with a specialist before treatment
• Children <12 months: Routine deworming not recommended 1

Pregnant Women

• Avoid albendazole and mebendazole if possible
• Pyrantel pamoate is preferred for intestinal helminth infections during pregnancy
• Defer treatment until after first trimester unless benefits outweigh risks 1

Treatment Monitoring and Follow-up

• Clinical follow-up in 2-4 weeks is recommended 1
• If symptoms persist or treatment fails:
  1. Repeat stool examination
  2. Consider alternative treatment options
  3. Evaluate for reinfection or misdiagnosis

Prevention of Reinfection

• Frequent handwashing with soap, especially after using toilet and before eating
• Keep fingernails short and clean
• Daily changing of underwear
• Environmental cleaning of living spaces
• Treat all household members simultaneously to prevent reinfection 1

Common Pitfalls to Avoid

1. Inadequate diagnosis: Ensure proper diagnosis through concentrated stool microscopy or fecal PCR 1
2. Incomplete household treatment: Treat all household members simultaneously to prevent reinfection 1
3. Insufficient hygiene measures: Emphasize importance of handwashing and environmental cleaning 1
4. Emerging resistance: Be aware of reduced efficacy of albendazole against certain parasite species (though Ascaris remains highly responsive) 1
5. Inadequate follow-up: Ensure follow-up in 2-4 weeks to confirm treatment success 1

Alternative Treatments

For cases of treatment failure or contraindications to first-line agents:

• Ivermectin 200 μg/kg as a single dose can be considered, though it's more commonly used for other parasitic infections 1, 4
• For mixed helminth infections, treatment selection should target all identified parasites 1

Safety Considerations

• Albendazole is generally safe for short-term use
• For treatment courses >14 days, monitor for hepatotoxicity (elevated liver enzymes in up to 16% of cases) and leukopenia (up to 10% of patients) 1
• No special procedures such as fasting or purging are required with mebendazole 2