What is the treatment for Enterobius vermicularis (pinworm) infection in pediatric patients?

From the Guidelines

The treatment for Enterobius vermicularis (pinworm) infection in pediatric patients is a single dose of Albendazole 400 mg or mebendazole 100 mg. This recommendation is based on the most recent and highest quality evidence available, which suggests that these medications are effective in treating pinworm infections in children 1. The treatment should be repeated after two weeks to kill any newly hatched worms and prevent reinfection.

Key Considerations

• The prepatent period for pinworm infection is 2-4 weeks, during which the worms mature and start laying eggs 1.
• The mode of transmission is through the faeco-oral route, highlighting the importance of good hygiene practices, such as regular handwashing, especially before eating and after using the bathroom.
• Clinical presentation may include intense pruritis ani, weight loss, irritability, diarrhoea, abdominal pain, and occasionally colitis with eosinophilia 1.
• Diagnosis is typically made using the ‘sellotape test’, which involves placing the sticky side of sellotape on the perianal skin and then examining it under the microscope for ova 1.

Comprehensive Treatment Approach

• All household members should be treated simultaneously, even if they don't have symptoms, due to the highly contagious nature of pinworm infections.
• Environmental measures are crucial and include washing all bedding, underwear, and pajamas in hot water, vacuuming sleeping areas thoroughly, and encouraging regular handwashing.
• It's also important to keep fingernails short and discourage nail-biting and scratching around the anus to prevent reinfection.

Outcome and Follow-Up

• Most children recover completely with proper treatment, though reinfection is common in group settings like schools and daycares.
• If symptoms persist after treatment, it's essential to consult a healthcare provider for further evaluation to rule out other potential causes or complications.

From the FDA Drug Label

Mebendazole tablets are indicated for the treatment of Enterobius vermicularis (pinworm), Trichuris trichiura (whipworm), Ascaris lumbricoides (common roundworm), Ancylostoma duodenale (common hookworm), Necator americanus (American hookworm) in single or mixed infections. Oral dosage is a single dose of 5 milligrams of pyrantel base per pound, or 11 milligrams per kilogram, of body weight not to exceed 1 gram.

The treatment for Enterobius vermicularis (pinworm) infection in pediatric patients is:

• Mebendazole (PO), as it is indicated for the treatment of pinworm infection 2
• Pyrantel pamoate (PO), with a single dose of 5 milligrams of pyrantel base per pound, or 11 milligrams per kilogram, of body weight not to exceed 1 gram 3

From the Research

Treatment Options for Enterobius Vermicularis Infection

• The drugs of choice for the treatment of pinworm infestation are mebendazole (100 mg), pyrantel pamoate (11 mg/kg, maximum 1 g), and albendazole (400 mg), all of which are given in a single dose and repeated in two weeks 4.
• Mebendazole and albendazole are both adulticidal and ovicidal, whereas pyrantel pamoate is only adulticidal 4.
• For pregnant women, pyrantel is preferred to mebendazole and albendazole 4.
• Treatment of all household members should be considered, especially if there are multiple or repeated symptomatic infections because reinfection is common even when effective medication is given 4, 5.

Efficacy of Treatment Options

• The approved antihelminthic agents are mebendazole, pyrantel embonate, and pyrvinium embonate, with success rates of up to >90% 5.
• Albendazole and mebendazole are commonly used to control hookworm, but have shortcomings in their efficacy profiles 6.
• Triple drug therapy with albendazole, pyrantel pamoate, and oxantel pamoate could be more effective than the co-administration of two drugs for the treatment of hookworm infections 6.

Diagnosis and Prevention

• The diagnosis of E. vermicularis infection is best established by the cellophane tape test, with a sensitivity of approximately 90% when performed on three different mornings 4.
• Good personal hygiene, such as frequent handwashing, especially after bowel movements and before meals, clipping of fingernails, avoidance of finger-sucking, nail-biting, and scratching in the anogenital area, are important preventive measures 4.
• Pinworm infections are diagnosed visually or by a tape test or paddle test, and albendazole and pyrantel pamoate are both effective treatments 7.