Treatment of Ascaris Lumbricoides Infection
The recommended first-line treatment for ascariasis is albendazole 400 mg as a single oral dose, which has a cure rate of approximately 95-100%. 1, 2
First-Line Treatment Options
- Albendazole 400 mg as a single oral dose is the preferred treatment with cure rates approaching 100% 1, 3
- Mebendazole 500 mg as a single oral dose is an equally effective alternative 1, 4
- Ivermectin 200 μg/kg as a single oral dose is another effective option with similar efficacy 1, 5
Medication Administration
- Albendazole can be administered as a single dose with no special preparation required 3
- Mebendazole tablets may be chewed, swallowed whole, or crushed and mixed with food 4
- No fasting or purging is required before or after treatment 4
Efficacy Considerations
- Single-dose albendazole has demonstrated 100% cure rates for Ascaris in clinical trials 3, 6
- Mebendazole has shown 98% efficacy against Ascaris lumbricoides 4
- Both medications achieve egg reduction rates of nearly 100% 5, 6
Special Clinical Scenarios
- For patients with Loeffler's syndrome (pulmonary manifestation of Ascaris migration), the same single-dose treatment is recommended 7, 8
- In cases of biliary obstruction or intestinal obstruction due to Ascaris, surgical intervention may be required in addition to anthelmintic therapy 1
- For patients with hyperinfestation syndrome (seen in immunocompromised individuals), more aggressive treatment may be necessary 2
Diagnostic Confirmation
- Diagnosis is typically made by concentrated stool microscopy 2, 1
- Direct visualization of adult worms passed in stool is diagnostic 1, 9
- PCR-based fecal testing offers higher sensitivity when available 1, 9
Follow-up Recommendations
- No specific follow-up is typically needed after successful treatment unless symptoms persist 1
- In endemic areas with high reinfection rates, periodic retreatment every 4-6 months may be necessary 6
- Reinfection rates can be significant, with studies showing approximately 54.5% reinfection with Ascaris within 4 months in endemic areas 6
Common Pitfalls and Caveats
- Failure to identify and treat all household members may lead to reinfection 5
- Caution should be exercised when using corticosteroids in cases of coinfection with Strongyloides 7
- Albendazole and mebendazole are generally well-tolerated with minimal side effects, which may include transient abdominal pain, nausea, or diarrhea 5
- In areas with poor sanitation, treatment alone without addressing environmental factors will lead to high reinfection rates 8, 6