What is the recommended treatment for pinworm infection?

Pinworm Treatment

The recommended first-line treatment for pinworm infection (Enterobius vermicularis) is a single dose of mebendazole 100 mg, pyrantel pamoate (11 mg/kg, maximum 1 g), or albendazole 400 mg, with a second dose repeated after two weeks to eradicate newly hatched parasites. 1

Treatment Options

First-Line Medications

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

  • FDA-approved with 95% cure rate for pinworm infections 2
  • Both adulticidal and ovicidal 1

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

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

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

  • Both adulticidal and ovicidal 1
  • Recommended by the American Society of Tropical Medicine and Hygiene for most intestinal helminths 3

Alternative Treatment

• Ivermectin: 200 μg/kg as a single dose 3
  • Useful for resistant cases or when first-line treatments are contraindicated 3

Treatment Considerations

Special Populations

• Pregnant women: Pyrantel pamoate is preferred; avoid mebendazole and albendazole if possible 3, 1
  • Treatment should be deferred until after the first trimester unless benefits outweigh risks 3

Household Treatment

• All household members should be treated simultaneously, especially if there are multiple or repeated symptomatic infections 1, 4
  • This is crucial for preventing reinfection cycles 1, 4

Persistent or Recurrent Infections

• For recurrent infections, consider a prolonged "pulse scheme" treatment for up to 16 weeks 4
• Follow-up with clinical evaluation in 2-4 weeks to assess treatment success 3

Diagnosis

• Cellophane tape test is the gold standard for diagnosis 3, 1
  • Single test sensitivity: ~50%
  • Three consecutive morning tests: ~90% sensitivity 3, 1
• Stool examination is not recommended as pinworms and eggs are not usually passed in stool 1
• Visual identification of worms in the perianal area can provide definitive diagnosis 1

Prevention and Hygiene Measures

• Hand hygiene: Frequent handwashing with soap, especially after using the toilet and before eating 3, 1
• Nail care: Keep fingernails short and clean; avoid nail-biting 3, 1
• Clothing: Change underwear daily 1
• Bedding: Wash bed linens frequently in hot water 1
• Bathing: Daily morning showers to remove eggs deposited overnight 1

Common Pitfalls to Avoid

1. Failing to repeat treatment: A single dose is insufficient; the second dose after 2 weeks is essential to break the lifecycle 1
2. Not treating all household members: This often leads to reinfection 1, 4
3. Neglecting hygiene measures: Treatment without improved hygiene leads to reinfection 3, 1
4. Inadequate diagnosis: Performing only one cellophane tape test may miss infections due to its limited sensitivity 3
5. Relying on stool examination: This is not recommended for pinworm diagnosis 1

The combination of appropriate medication, repeated dosing, household-wide treatment, and strict hygiene measures provides the most effective approach to eradicating pinworm infection and preventing recurrence.