What is the recommended treatment for pinworms (Enterobius vermicularis) in a 7-year-old child?

Treatment of Pinworms in a 7-Year-Old Child

The recommended first-line treatment for pinworms (Enterobius vermicularis) in a 7-year-old child is a single dose of albendazole 400 mg or mebendazole 100 mg, with a repeat dose in 2 weeks to eradicate any newly hatched worms. 1, 2

Medication Options

First-Line Treatments:

• Albendazole 400 mg as a single oral dose, repeated in 2 weeks 1, 3
• Mebendazole 100 mg as a single oral dose, repeated in 2 weeks 2, 3

Alternative Treatment:

• Pyrantel pamoate at a dose of 11 mg/kg (not exceeding 1 gram) as a single dose, repeated in 2 weeks 4, 3

Treatment Considerations

Medication Efficacy:

• Mebendazole has approximately 95% cure rate for pinworm infections 2
• Albendazole and mebendazole are both adulticidal and ovicidal (kill both adult worms and eggs) 3
• Pyrantel pamoate is only adulticidal (kills adult worms but not eggs) 3

Treatment Protocol:

• A second dose 2 weeks after initial treatment is essential to kill newly hatched worms that may have survived the first treatment 3
• Treatment of all household members should be considered, especially if there are multiple or repeated symptomatic infections, as reinfection is common 3, 5

Clinical Presentation

Common Symptoms:

• Nocturnal perianal itching is the most common symptom 1, 3
• Other symptoms may include weight loss, irritability, diarrhea, and abdominal pain 1
• Female genital tract colonization may occur, causing vaginal discharge in girls 1, 6
• Approximately 30-40% of infected patients are asymptomatic 3

Diagnosis

Diagnostic Methods:

• The "sellotape test" (adhesive tape test) is the preferred diagnostic method - performed by placing the sticky side of tape on the perianal skin in the morning before bathing or defecation, then examining under microscope for ova 1, 3
• The sensitivity of a single test is around 50%, but increases to approximately 90% with tests performed on three different mornings 3
• Stool examination is not recommended as pinworms and eggs are not usually passed in the stool 3

Prevention and Management

Hygiene Measures:

• Frequent handwashing, especially after bowel movements and before meals 3
• Regular changing and washing of underwear, bedding, and nightclothes 5
• Clipping of fingernails and discouraging nail-biting and finger-sucking 3
• Daily bathing or showering in the morning to remove eggs deposited overnight 5

Common Pitfalls to Avoid:

• Failure to treat all household members simultaneously, leading to reinfection cycles 3, 5
• Inadequate hygiene measures during and after treatment 3
• Not completing the full treatment course with the second dose at 2 weeks 3
• Overlooking potential vaginal infection in girls, which can serve as a reservoir for reinfection 6

Special Considerations

Recurrent Infections:

• Consider treating the entire household if infections recur 3, 5
• Ensure thorough cleaning of the home environment, including washing bedding and clothing in hot water 5
• In cases of persistent infection despite appropriate treatment, consider ectopic sites of infection such as the vagina in girls 6