What is the recommended treatment for pinworms?

Treatment of Pinworms (Enterobius vermicularis)

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

Recommended Medications

First-line options:

• Albendazole: 400 mg as a single dose, repeated in 2 weeks 1, 2
• Mebendazole: 100 mg as a single dose, repeated in 2 weeks 1, 3, 2
  • Mebendazole has a 95% cure rate for pinworm infections 3

Alternative options:

• Pyrantel pamoate: 11 mg/kg (maximum 1 g) as a single dose, repeated in 2 weeks 1, 4, 2
  • Preferred option for pregnant women 1, 2
• Ivermectin: 200 μg/kg as a single dose when first-line treatments fail or are contraindicated 1

Treatment Algorithm

1. Initial treatment: Administer albendazole 400 mg or mebendazole 100 mg as a single dose
2. Repeat treatment: Give second dose 2 weeks after initial treatment to kill newly hatched worms
3. Treat all household members simultaneously to prevent reinfection 1, 2
4. For treatment failures: Consider ivermectin 200 μg/kg as a single dose 1

Special Populations

Children:

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

Pregnant women:

• Pyrantel pamoate is preferred over albendazole and mebendazole 1, 2
• Defer treatment until after first trimester unless benefits outweigh risks 1

Prevention of Reinfection

Pinworm reinfection is common due to the short life cycle of the parasite and ease of transmission. Implement these preventive measures along with medication:

• Frequent handwashing with soap, especially after using the toilet and before eating 1
• Keep fingernails short and clean 1
• Daily changing of underwear 1
• Environmental cleaning of living spaces 1
• Avoid behaviors like nail-biting and finger-sucking 2, 5

Diagnosis Confirmation

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

• Single test: ~50% sensitivity
• Three consecutive morning tests: ~90% sensitivity 1

Common Pitfalls to Avoid

1. Failing to treat all household members simultaneously - This is essential to prevent reinfection cycles 1, 2
2. Inadequate hygiene measures - Medications alone are insufficient without proper hygiene 1
3. Insufficient follow-up - Consider clinical follow-up in 2-4 weeks for persistent symptoms 1
4. Overlooking female genital tract involvement - Pinworms can occasionally cause vaginal discharge 1, 6, 7

By following this comprehensive approach of appropriate medication, repeated dosing, household-wide treatment, and strict hygiene measures, most pinworm infections can be successfully eradicated.