What is the recommended treatment for pinworm infestation in a baby over 6 months old?

Treatment of Pinworm Infestation in Babies Over 6 Months Old

For babies over 6 months old with pinworm infestation, a single dose of albendazole 400 mg or mebendazole 100 mg is recommended, 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 dose, repeated in 2 weeks 1, 2
  • Mebendazole 100 mg as a single dose, repeated in 2 weeks 1, 2

• Alternative treatment:

  • Pyrantel pamoate at a dose of 11 mg/kg (not to exceed 1 gram) as a single dose, repeated in 2 weeks 3, 4
  • Pyrantel pamoate is dosed by weight and can be used in children over 2 years of age; for children under 2 years, physician direction is required 3

Clinical Presentation

• The most common symptom of pinworm infestation is nocturnal perianal itching 1, 4
• Other symptoms may include:
  • Weight loss and irritability 1, 2
  • Diarrhea and abdominal pain 1, 2
  • In girls, vaginal colonization may occur, causing vaginal discharge 1, 2
• Approximately 30-40% of infested patients may be asymptomatic 4

Diagnostic Approach

• The diagnosis is best established using the "sellotape test" (adhesive tape test) performed by placing the sticky side of tape on the perianal skin in the morning, then examining it under a microscope for ova 1, 4
• The sensitivity of a single test is around 50%, but increases to approximately 90% with tests performed on three different mornings 4
• Visual identification of adult worms in the perianal area or stool is also diagnostic 4

Treatment Considerations

• When one individual in a household has pinworms, the entire household should be treated to prevent reinfection 3, 4
• Medication can be taken any time of day, with or without meals, and may be taken alone or with milk or fruit juice 3
• A laxative is not necessary before, during, or after medication 3

Prevention and Management of Recurrence

• Good personal hygiene is essential to prevent reinfection 4:
  • Frequent handwashing, especially after bowel movements and before meals
  • Clipping of fingernails
  • Avoidance of finger-sucking and nail-biting
  • Regular changing and washing of bedding and underwear

Important Caveats

• Recurrences are common despite effective treatment, likely due to repeated cycles of reinfection (particularly autoinfection) because of the short life span of adult pinworms 4
• If symptoms or pinworms persist after treatment, consult a doctor 3
• If any worms other than pinworms are present before or after treatment, consult a doctor 3