Treatment of Hookworm Infection in a Family of Four
Treat all four family members with albendazole 400 mg orally as a single dose, repeated in 2 weeks, regardless of whether stool testing confirms infection. 1
Rationale for Empiric Treatment
Given the prolonged residence in an endemic area (6 years in Mexico) and suspected infection duration of at least 2 years, empiric treatment is warranted even without confirmed diagnosis. 1 The limitations of stool microscopy are significant—standard diagnostic techniques can miss infections, and multiple stool samples may still yield false-negative results due to intermittent egg shedding. 1, 2
Specific Treatment Regimen
For Both Adolescents (Ages 12 and 15) and Parents:
- Albendazole 400 mg orally as a single dose 1, 3
- Repeat the same dose in 2 weeks 1
- This regimen is effective against both Ancylostoma duodenale and Necator americanus (the two hookworm species) 1, 3
Alternative Consideration:
If you want broader empiric coverage for other possible geohelminth infections (given the prolonged exposure and eosinophilia if present), consider adding ivermectin 200 μg/kg as a single dose on the same day as the first albendazole dose. 1, 2 This combination provides coverage for Strongyloides and other parasites that may have been acquired during the 6-year residence.
Monitoring and Follow-up
- Monitor for hepatotoxicity and leukopenia if treatment extends beyond 14 days (not applicable for standard 2-dose regimen, but important if repeated courses are needed). 4
- Repeat stool examination 2-3 weeks after the second dose if symptoms persist (anemia, abdominal pain, or fatigue). 1
- The cure rate for hookworm with albendazole 400 mg is approximately 96% with egg reduction rates of 99%. 3, 5
Clinical Presentation to Monitor
Hookworm infection can manifest as: 1
- Anemia (particularly concerning given the 2-year suspected infection duration—check hemoglobin levels in all family members)
- Abdominal pain, nausea, diarrhea
- "Ground itch" at sites of larval skin penetration (feet if walking barefoot)
- Fatigue and weakness from chronic blood loss
Prevention of Reinfection
Critical measures to prevent reinfection: 1
- Wear shoes consistently, especially outdoors—hookworm larvae penetrate through bare skin contact with contaminated soil
- Hand hygiene before meals
- Proper sanitation practices
- Consider treating the family again in 6-12 months if they remain in or return to the endemic area
Important Caveats
Albendazole is superior to mebendazole for hookworm. 6 If albendazole is unavailable, mebendazole 100 mg twice daily for 3 days is an alternative, but cure rates are significantly lower (29% vs 69% for single-dose regimens). 6
Do not use ivermectin if there is any possibility of Loa loa exposure (West/Central Africa travel), as severe reactions can occur. 2 Mexico is not a Loa loa endemic area, so this is not a concern for this family.
The same dosing applies to both adults and children over 12 years of age—no dose adjustment is needed. 1