Treatment of Hookworm Infection
The recommended treatment for hookworm infection is albendazole 400 mg orally with a repeat dose in 2 weeks. 1
First-line Treatment
- Albendazole 400 mg as a single oral dose, repeated in 2 weeks, is the recommended regimen for hookworm infections (Ancylostoma duodenale and Necator americanus) 1
- This treatment regimen is highly effective, with cure rates of approximately 78% overall for hookworm infections 2
- Species-specific cure rates are higher for Ancylostoma duodenale (92%) compared to Necator americanus (75%) 2
Alternative Treatment Options
- Mebendazole can be used as an alternative, but is less effective against hookworm compared to albendazole 3
- Mebendazole has significantly lower cure rates (29% for single dose) compared to albendazole (69% for single dose) 3
- If using mebendazole, the FDA-approved dosing is 100 mg twice daily for 3 consecutive days 4
Clinical Presentation
- Hookworm infection is often asymptomatic but may present with: 1
- Transient itching ("ground itch") at the site of larval skin penetration
- Maculopapular rash
- Nausea, vomiting, diarrhea, and abdominal pain
- Anemia in heavy infections, particularly in young children
Diagnostic Approach
- Diagnosis is made through concentrated stool microscopy or fecal PCR 1
- Multiple stool samples may be needed to increase diagnostic yield due to intermittent egg shedding 1
Treatment Efficacy Considerations
- Single-dose albendazole has shown egg reduction rates of 97-99.7%, which is higher than the egg reduction rates with mebendazole (84-96%) 3
- For heavy infections or cases with incomplete response, triple-dose regimens of albendazole (400 mg daily for 3 consecutive days) have shown higher cure rates (92%) compared to single-dose regimens (69%) 3
Special Populations
- The same dosing regimen (albendazole 400 mg with repeat in 2 weeks) applies to both adults and children 1, 5
- For preschool and school-aged children, the current recommended dose of 400 mg is considered sufficient 6
- For adults with heavy infections, some evidence suggests that higher doses (800 mg) may provide better cure rates (94.1%) 6
Follow-up and Monitoring
- If symptoms persist after treatment, consider repeating stool examination 2-3 weeks after treatment 5
- In cases of persistent infection, consider alternative diagnoses or resistant infection 5