Multi-Day Albendazole Treatment for Hookworm
For hookworm infection, the recommended treatment is albendazole 400 mg orally once daily for 3 consecutive days. 1
Treatment Rationale
The 3-day regimen is specifically recommended by the most recent UK guidelines (2025) for hookworm infections caused by Ancylostoma duodenale and Necator americanus. 1 This multi-day approach provides superior cure rates compared to single-dose therapy, particularly important given that heavy hookworm infections can cause significant anemia, especially in young children. 1
Clinical Context
- Prepatent period: 5-9 weeks after larval skin penetration 1
- Transmission: Larvae penetrate skin during barefoot walking on contaminated soil; some species can be acquired orally 1
- Clinical presentation: Often asymptomatic, but may present with initial "ground itch" and maculopapular rash, followed weeks later by gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain) 1
- Key complication: Heavy infections cause anemia, particularly problematic in young children 1
Diagnostic Approach
- Concentrated stool microscopy or fecal PCR are the diagnostic tests of choice 1
Evidence Supporting Multi-Day Regimen
While older guidelines (2010) recommended single-dose albendazole 400 mg 1, the most recent evidence demonstrates that triple-dose regimens significantly outperform single doses for hookworm. 2 Research shows that:
- Single-dose albendazole achieves 69% cure rate 2
- Triple-dose albendazole achieves 92% cure rate 2
- Egg reduction rates improve from 97% (single dose) to 99.7% (triple dose) 2
A dose-finding trial in adults demonstrated that even higher single doses (up to 800 mg) achieved only 74.9-94.1% cure rates 3, suggesting that multi-day standard dosing (400 mg daily × 3 days) remains the optimal balance of efficacy and practicality for routine practice.
Severe Disease Management
In severe hookworm disease with significant symptoms, add prednisolone 40-60 mg orally once daily. 1 Seek specialist advice as intensive care management may be needed in severe cases. 1
Important Clinical Pitfalls
- Do not use single-dose therapy when treating diagnosed hookworm infection—the 3-day regimen is specifically recommended to achieve adequate cure rates 1
- Assess for anemia in all patients, particularly children and those with heavy infections 1
- Consider co-infections: Hookworm commonly coexists with other soil-transmitted helminths; concentrated stool microscopy may reveal mixed infections requiring adjusted treatment 1
- Reinfection risk: Conditions conducive to reinfection are common in endemic areas; patient education about wearing shoes and sanitation is essential 4
Alternative Single-Dose Regimens (When Multi-Day Not Feasible)
If the 3-day regimen is not feasible, albendazole 400 mg as a single dose remains an acceptable alternative 1, though with lower cure rates. 2 Albendazole is superior to mebendazole for hookworm at equivalent dosing. 2, 5