What is the recommended treatment for pinworms (enterobiasis) in a child?

Treatment of Pinworms in Children

The recommended first-line treatment for pinworm (Enterobius vermicularis) infection in children is a single dose of mebendazole 100 mg, repeated after 2 weeks to eradicate newly hatched worms. 1, 2

First-Line Treatment Options

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

  • Tablet may be chewed, swallowed, or crushed and mixed with food
  • Both adulticidal and ovicidal
  • FDA-approved with 95% cure rate

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

  • Both adulticidal and ovicidal
  • Highly effective alternative

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

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

Diagnosis

The diagnosis of pinworm infection is best established using the cellophane tape test:

• Performed in the morning before bathing or defecation
• Apply clear adhesive tape to the perianal area
• Examine tape under microscope for eggs
• Single test sensitivity is approximately 50%
• Sensitivity increases to about 90% when performed on three consecutive mornings 3, 2

Treatment Considerations

Special Populations

• Pregnant women: Pyrantel pamoate is preferred over mebendazole or albendazole 3, 2
• Household members: Consider treating all household members simultaneously, especially with multiple or repeated infections 2, 4

Treatment Failure

If infection persists after initial treatment course:

• Repeat the treatment regimen
• For recurrent infections, consider prolonged "pulse" treatment for up to 16 weeks 4
• Consider alternative medications if standard treatments fail

Prevention of Reinfection

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

• Hand hygiene: Frequent handwashing with soap, especially after using the toilet and before eating 3, 2
• Nail care: Keep fingernails short and clean, discourage nail-biting 3, 2
• Clothing and bedding: Change and wash underwear, pajamas, and bed sheets frequently 2
• Environmental cleaning: Regular cleaning of toilet seats, bathroom fixtures, and toys 2
• Behavioral modifications: Discourage scratching of the perianal area and finger-sucking 2

Common Pitfalls to Avoid

1. Failing to repeat treatment: A single dose is insufficient as it doesn't kill eggs, which can hatch and cause reinfection
2. Not treating household members: Family members often have asymptomatic infections that can lead to reinfection
3. Relying on stool examination: Pinworms rarely appear in stool samples; the cellophane tape test is the diagnostic method of choice
4. Neglecting hygiene measures: Medication alone without hygiene improvements often leads to reinfection
5. Overlooking asymptomatic infections: Approximately 30-40% of infected patients show no symptoms 2

Pinworm infections, while uncomfortable, are generally benign and respond well to appropriate treatment. The key to successful management is proper medication administration combined with thorough hygiene measures to prevent reinfection.