Hookworm Treatment Plan
First-Line Treatment
Treat hookworm infection with albendazole 400 mg orally as a single dose, repeated in 2 weeks. 1
This regimen is effective against both Ancylostoma duodenale and Necator americanus, the two species causing human hookworm infection. 1 The FDA label confirms albendazole's indication for both common hookworm (A. duodenale) and American hookworm (N. americanus) with a 96% cure rate and 99% egg reduction rate. 2
Dosing Details
- Adults and children: Albendazole 400 mg orally, single dose, repeated in 2 weeks 1
- Children 12-24 months: Seek expert consultation before treatment 1
- The repeat dose at 2 weeks is critical to ensure eradication, as single-dose cure rates may be incomplete 1
Alternative Treatment Options
If albendazole is unavailable or contraindicated, use one of these alternatives:
- Mebendazole 500 mg as a single oral dose 3
- Mebendazole 100 mg twice daily for 3 days (for more severe infections, consider combining with ivermectin 200 μg/kg once daily) 3
- Ivermectin 200 μg/kg as a single dose, particularly when benzimidazoles are not available 3
The FDA label confirms mebendazole's efficacy for hookworm with a 96% cure rate and 99% egg reduction rate. 2
Empiric Treatment for Suspected But Unconfirmed Infection
For patients with prolonged exposure in endemic areas and negative stool tests, treat empirically with albendazole 400 mg plus ivermectin 200 μg/kg as a single dose. 1
This combination approach is warranted because:
- Standard stool microscopy (even 3 samples on different days) has high false-negative rates 1
- Long-term residence in endemic areas significantly increases exposure risk despite negative testing 1
- The combination targets possible undetected geohelminth infections 1
Monitoring and Follow-Up
Post-Treatment Assessment
- Repeat stool examination 2-3 weeks after treatment if symptoms persist 1, 3
- Consider alternative diagnoses or resistant infection if initial treatment fails 1, 3
- Retreatment with an alternative agent may be necessary 3
Extended Treatment Monitoring
- Monitor for hepatotoxicity and leukopenia if treatment extends beyond 14 days 1
Management of Anemia
Address iron-deficiency anemia with iron supplementation in patients with heavy infections. 3
Hookworm causes blood loss through intestinal attachment, and anemia is particularly common in young children and those with heavy worm burdens. 1, 3 Do not overlook iron supplementation as part of comprehensive management. 3
Special Populations
Pregnant Women
- Delay treatment until after the first trimester unless infection is severe 3
Children
- Same single-dose regimen applies to children as adults 1, 3
- For children 12-24 months, expert consultation is recommended 1
Areas with Known Resistance
- Use ivermectin 200 μg/kg as a single dose in areas with documented mebendazole resistance 3
Prevention of Reinfection
Implement these measures to prevent reinfection:
- Hand hygiene and wearing shoes in endemic areas are essential 1, 3
- Screen and treat household contacts in endemic settings 1, 3
Common Pitfalls to Avoid
- Inadequate dosing for severe infections: Consider combination therapy (mebendazole plus ivermectin) for heavy infections 3
- Forgetting the repeat dose: The 2-week repeat of albendazole is critical for complete eradication 1
- Overlooking anemia: Always assess for and treat iron-deficiency anemia in hookworm patients 3
- Relying solely on negative stool tests: In endemic-exposed patients, empiric treatment may be warranted despite negative testing 1
Cutaneous Larva Migrans (Dog/Cat Hookworm)
For the distinct entity of cutaneous larva migrans caused by Ancylostoma braziliense or A. caninum (dog/cat hookworms):
This presents as a characteristic self-limiting itchy, serpiginous rash migrating at 1-2 cm per day and is clinically diagnosed. 4 This is distinct from "ground itch," the blister-like eruption at the point of entry of human hookworm larvae. 4