What is the recommended treatment for pinworms?

Pinworm Treatment

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

Medication Options

First-Line Agents

• Albendazole 400 mg: Single oral dose, repeated in 2 weeks 1, 2
• Mebendazole 100 mg: Single oral dose, repeated in 2 weeks 1, 2, 3
• Both medications are adulticidal and ovicidal, making them superior to alternatives 4

Alternative Agent

• Pyrantel pamoate: 11 mg/kg (maximum 1 gram) as a single dose, repeated in 2 weeks 5, 4
  • This is only adulticidal (not ovicidal), making it less effective than albendazole or mebendazole 4
  • Preferred in pregnancy due to safety profile 4

Critical Treatment Principles

The Two-Week Repeat Dose is Mandatory

• The second dose at 2 weeks is essential to kill newly hatched worms from eggs that survived the initial treatment 1, 2
• Failure to repeat dosing is a common pitfall leading to treatment failure 1

Household Treatment Strategy

• Treat all household members simultaneously, especially when there are multiple or repeated symptomatic infections 4, 6
• This approach prevents the ping-pong effect of reinfection within households 6

Special Populations

Pregnant Women

• Pyrantel pamoate is the preferred agent over albendazole and mebendazole during pregnancy 4

Young Children

• Standard dosing applies to children 2 years and older 5
• For children under 2 years, consult with a specialist before treatment 5

Recurrent or Refractory Infections

Prolonged Pulse Therapy

• For recurrent infections despite standard treatment, consider prolonged therapy for up to 16 weeks using a "pulse scheme" 6
• This extended approach addresses repeated cycles of autoinfection 6

Hygiene Measures (Essential Adjunct)

While medication is the primary treatment, these measures reduce reinfection risk:

• Frequent handwashing, especially after bowel movements and before meals 4
• Clipping fingernails short 4
• Avoiding nail-biting, finger-sucking, and scratching the perianal area 4
• Morning bathing to remove eggs deposited overnight 4

Common Pitfalls to Avoid

• Forgetting the 2-week repeat dose: This is the most common cause of treatment failure 1, 2
• Treating only the symptomatic individual: Household transmission is extremely common, requiring simultaneous treatment of all members 4, 6
• Expecting stool examination to confirm diagnosis: Pinworms and eggs are rarely found in stool; the cellophane tape test is the diagnostic method of choice 2, 4

Clinical Presentation to Recognize

• Nocturnal perianal itching is the hallmark symptom 1, 2
• In females, vaginal discharge may occur from genital tract colonization 1, 2
• Other symptoms include irritability, weight loss, diarrhea, and abdominal pain 1, 2