What is the recommended treatment for pediatric enterobiasis (pinworms) or intestinal worms?

Treatment of Pediatric Pinworms (Enterobiasis)

First-line treatment for pediatric pinworm infection is albendazole 400 mg or mebendazole 100 mg as a single oral dose, repeated after 2 weeks to eradicate newly hatched parasites. 1

Medication Options

First-line treatments:

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

  • Advantages: Both adulticidal and ovicidal
  • Safe and effective for children

• Mebendazole: 100 mg as a single dose, repeated after 2 weeks 3, 2

  • FDA-approved for pinworm treatment with 95% cure rate 3
  • Can be chewed, swallowed, or crushed and mixed with food 3
  • Both adulticidal and ovicidal

Alternative treatments:

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

  • Only adulticidal, not ovicidal
  • Preferred option for pregnant women 2

• Mebendazole: 100 mg twice daily for 3 consecutive days (alternative dosing) 1, 4

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

Treatment Considerations

Family/Household Treatment

• Treat all household members simultaneously to prevent reinfection 2, 4
  • Particularly important with multiple or repeated infections
  • Reinfection is common even with effective medication

Persistent/Recurrent Infections

• For recurrent infections, consider prolonged "pulse" treatment for up to 16 weeks 4
• Recurrence is often due to autoinfection or reinfection from household members 2
• Consider the possibility of ectopic infections (e.g., vaginal) as potential reservoirs 5

Special Populations

• Pregnant women: Pyrantel pamoate is preferred over mebendazole and albendazole 2
• Children under 2 years: Consult with pediatrician for appropriate dosing

Prevention and Hygiene Measures

Essential hygiene practices:

• Frequent handwashing, especially after using the bathroom and before meals 2
• Keep fingernails short and clean 1
• Avoid finger-sucking and nail-biting 2
• Daily morning showers/bathing to remove eggs laid overnight
• Change underwear and bedding daily during treatment
• Wash bed linens in hot water 1
• Clean bathroom surfaces regularly 1

Follow-up

• Perform follow-up stool examination 2-4 weeks after treatment to confirm clearance 1
• The cellophane tape test is the preferred diagnostic method (50% sensitivity with one test, 90% with three tests on different mornings) 2

Clinical Pearls

• Pinworm infection affects approximately 30% of children worldwide and up to 60% in some developing countries 2
• Most common in children 5-14 years old 2
• Nocturnal perianal itching is the most common symptom, but 30-40% of infected patients are asymptomatic 2
• Stool examination is not recommended for diagnosis as pinworms and eggs are not usually passed in stool 2
• Ectopic infections can occur, particularly in the female genital tract, and may serve as reservoirs for reinfection 5

By following this treatment approach and implementing proper hygiene measures, most pinworm infections can be successfully eradicated with minimal complications.