What is the recommended treatment for enterobiasis (pinworm infection)?

Treatment of Pinworms (Enterobiasis)

For pinworm (Enterobius vermicularis) infection, a single dose of albendazole 400 mg or mebendazole 100 mg is the recommended first-line treatment, with the dose repeated after 2 weeks to prevent reinfection. 1

Medication Options

First-line treatments:

• Mebendazole: 100 mg as a single dose 2

  • FDA-approved specifically for pinworm treatment
  • Cure rate of approximately 95% 2
  • Can be chewed, swallowed, or crushed and mixed with food 2

• Albendazole: 400 mg as a single dose 1

  • Equally effective alternative to mebendazole
  • Both adulticidal and ovicidal activity 3

Alternative treatment:

• Pyrantel pamoate: 11 mg/kg (maximum 1 g) as a single dose 3
  • Preferred option for pregnant women as it has better safety profile during pregnancy 3
  • Note: Only adulticidal (not ovicidal) 3

Treatment Protocol

1. Initial treatment: Administer single dose of chosen medication 1

2. Repeat treatment: A second dose should be given 2 weeks after initial treatment to kill newly hatched worms and prevent reinfection 3

3. Household treatment: Consider treating all household members simultaneously, especially with multiple or repeated infections 3

   • Family members often harbor asymptomatic infections that can lead to reinfection 4

4. For recurrent infections: Consider extended "pulse scheme" treatment for up to 16 weeks in cases of persistent infection 4

Diagnosis

• Cellophane tape test (scotch tape or "sellotape" test): Most accurate diagnostic method 1

  • Apply adhesive tape to perianal region in the morning before bathing/defecation
  • Examine tape under microscope for ova
  • Single test sensitivity ~50%, increases to ~90% with tests performed on three different mornings 3

• Direct visualization: Adult worms may sometimes be visible in the perianal area or stool 3

• Note: Stool examination is not recommended as pinworms and eggs are not usually passed in stool 3

Preventive Measures

• Personal hygiene: Frequent handwashing, especially after bowel movements and before meals 3

• Environmental measures:

  • Daily changing of underwear 4
  • Regular washing of bedding and clothing in hot water 3
  • Clipping fingernails short to reduce egg accumulation 3

• Behavioral interventions:

  • Avoid finger-sucking, nail-biting, and scratching in the anogenital area 3
  • Supervise young children's hygiene practices 4

Clinical Considerations

• Most common symptom: Nocturnal perianal pruritus (itching) 1, 3

• Other symptoms may include:

  • Weight loss, irritability, diarrhea, abdominal pain 1
  • Occasionally colitis with eosinophilia 1
  • In females: vaginal discharge due to migration of worms to genital tract 1

• Approximately 30-40% of infected patients are asymptomatic 3

• Highest prevalence: Children aged 5-14 years 3, 4

Remember that despite effective treatment, recurrences are common due to the short life cycle of pinworms and potential for autoinfection. Combining medication with proper hygiene measures is essential for successful eradication 3, 4.