What is the recommended treatment for pinworms?

Pinworm Treatment Recommendations

The recommended first-line treatment for pinworm infection is a single oral dose of albendazole 400 mg or mebendazole 100 mg, with a repeat dose in 2 weeks to eradicate newly hatched worms. 1, 2

Medication Options

• Albendazole 400 mg as a single oral dose is an effective first-line treatment option for pinworm infections, as recommended by the American College of Physicians 2
• Mebendazole 100 mg as a single oral dose is equally effective, with cure rates of approximately 95% according to FDA labeling 3
• Pyrantel pamoate is another effective option, dosed at 11 mg/kg (maximum 1 g) as a single dose 4, 5
• All treatments should be repeated after 2 weeks to kill newly hatched worms and prevent reinfection 1, 2, 5

Special Population Considerations

• For pregnant women, pyrantel pamoate is preferred over mebendazole and albendazole due to safety concerns 5
• The same dosing regimens apply to both adults and children, though pyrantel pamoate has specific weight-based dosing instructions for children 4
• For children under 2 years of age, consult a physician before administering treatment 4

Clinical Presentation

• Nocturnal perianal itching is the most common symptom of pinworm infection 1, 2
• Other symptoms may include weight loss, irritability, diarrhea, abdominal pain, and occasionally colitis with eosinophilia 2
• In females, pinworms may colonize the genital tract, causing vaginal discharge 1, 6

Diagnosis

• The cellophane tape test (also called "sellotape test") is the preferred diagnostic method 1, 2
• The test should be performed by placing adhesive tape on the perianal skin in the morning before bathing or defecation to collect eggs 2
• The sensitivity of a single test is approximately 50%, but increases to about 90% when performed on three consecutive mornings 5
• Stool examination is not recommended for diagnosis as pinworms and eggs are not usually passed in the stool 5

Prevention of Reinfection

• Treatment of all household members should be considered, especially if there are multiple or repeated symptomatic infections 4, 5
• Good personal hygiene practices are essential, including:
  • Frequent handwashing, especially after bowel movements and before meals 5, 7
  • Clipping fingernails short 5
  • Avoiding finger-sucking, nail-biting, and scratching in the anogenital area 5, 7
  • Daily changing of underwear and bedding during treatment 7

Common Pitfalls and Caveats

• Reinfection is common even with effective medication due to the short life cycle of pinworms and potential for autoinfection 5, 7
• For recurrent infections, consider a prolonged "pulse scheme" treatment for up to 16 weeks 7
• Pinworm prevalence can be as high as 30-50% in some communities, making it an important public health concern 6
• Transmission occurs not only through direct contact but also through inhalation and ingestion of airborne eggs 6
• Risk factors include age 4-11 years, poor hand hygiene, nail-biting, and inadequate supervision of body hygiene 7