What is the treatment for enterobiasis (pinworm infection)?

Treatment of Pinworm Infection (Enterobiasis)

The first-line treatment for pinworm infection is a single oral dose of albendazole 400 mg, mebendazole 100 mg, or pyrantel pamoate 11 mg/kg (maximum 1 g), with a repeat dose in 2 weeks to eradicate any newly hatched worms. 1, 2

Medication Options

• Mebendazole 100 mg as a single oral dose is highly effective with cure rates of approximately 95% for pinworm infections 3
• Albendazole 400 mg as a single oral dose is an equally effective alternative 1, 2
• Pyrantel pamoate 11 mg/kg (maximum 1 g) is another effective option, especially preferred during pregnancy 4, 2
• All treatments should be repeated after 2 weeks to address newly hatched worms and prevent reinfection 2, 5
• Mebendazole and albendazole are both adulticidal and ovicidal, whereas pyrantel pamoate is only adulticidal 2

Treatment Considerations

• Treatment of all household members should be considered, especially if there are multiple or repeated symptomatic infections, as reinfection is common 2, 5
• For pregnant women, pyrantel pamoate is preferred over mebendazole and albendazole due to safety considerations 2
• In cases of recurrent infections, prolonged treatment for up to 16 weeks using a "pulse scheme" may be recommended 5
• For pinworm infections affecting genitourinary organs, treatment with two oral agents and topical therapy for the eggs may be warranted 6

Prevention of Reinfection

• Good personal hygiene is essential, including frequent handwashing, especially after bowel movements and before meals 2
• Clipping fingernails short, avoiding finger-sucking, nail-biting, and scratching in the anogenital area are important preventive measures 2, 5
• Daily changing of underwear and bedsheets during treatment can help prevent reinfection 5
• Proper washing of clothes, bedding, and toys in hot water can help eliminate eggs 2

Clinical Manifestations

• Approximately 30-40% of infected patients are asymptomatic 2
• The most common symptom is nocturnal perianal itching (pruritus ani) 1, 2
• Other symptoms may include irritability, restlessness, insomnia, weight loss, diarrhea, and abdominal pain 1, 2, 7
• In girls, female genital tract colonization may occur, causing vaginal discharge 1
• Scratching may lead to skin irritation, eczematous dermatitis, hemorrhage, or secondary bacterial infections 7

Diagnosis

• The cellophane tape test is the preferred diagnostic method, with sensitivity of approximately 50% for a single test, increasing to 90% with tests performed on three different mornings 1, 2
• Visual identification of worms in the perianal area or stool can provide definitive diagnosis 2
• Stool examination is not recommended as pinworms and eggs are not usually passed in the stool 2

Epidemiology

• Pinworm infection affects approximately 30% of children worldwide and up to 60% of children in some developing countries 2
• Children aged 5-14 years show the highest prevalence of enterobiasis 2
• Prevalence rates in some communities can be as high as 30-50% 6
• Transmission occurs primarily through the fecal-oral route, but inhalation and ingestion of airborne eggs can also occur 2, 6