What is the recommended dose of Albendazole (anti-parasitic medication) for treating parasitic infections?

Albendazole Dosing for Parasitic Infections

Standard Single-Dose Regimen

For most common intestinal parasitic infections in adults and children, albendazole 400 mg as a single oral dose is the recommended treatment. 1

This single-dose regimen is effective for:

• Ascariasis (roundworm): 400 mg single dose 1
• Enterobiasis (pinworm): 400 mg single dose 1
• Hookworm (initial treatment): 400 mg single dose, with repeat dose in 2 weeks 1, 2

Multi-Day Treatment Regimens

For infections requiring extended therapy, the following regimens apply:

Common Intestinal Parasites

• Hookworm (complete treatment): 400 mg daily for 3 days 1
• Strongyloidiasis (normal immunity): 400 mg twice daily for 3-7 days (though ivermectin 200 μg/kg single dose is preferred) 1
• Visceral larva migrans (Toxocariasis): 400 mg twice daily for 5 days 1
• Pulmonary eosinophilia: 400 mg twice daily for 5-7 days 3

Tissue Parasites (FDA-Approved Indications)

• Neurocysticercosis: For patients ≥60 kg, 400 mg twice daily with meals for 8-30 days; for patients <60 kg, 15 mg/kg/day divided twice daily (maximum 800 mg/day) 4
• Hydatid disease: For patients ≥60 kg, 400 mg twice daily with meals for 28-day cycles followed by 14-day drug-free intervals, for 3 total cycles; for patients <60 kg, 15 mg/kg/day divided twice daily (maximum 800 mg/day) 4

Special Situations

• Loiasis: 400 mg daily for 10-28 days for high microfilarial loads; 800 mg daily may be used for treatment failure 1
• Microsporidiosis: 7.5 mg/kg (maximum 400 mg/dose) twice daily until immune reconstitution 1

Empirical Treatment for Suspected Parasitic Infection

For travelers or migrants from endemic areas with suspected but undetected parasitic infection (such as unexplained eosinophilia with negative stool studies), a single dose of albendazole 400 mg plus ivermectin 200 μg/kg is recommended. 1, 2

This combination approach is particularly useful when:

• Multiple stool examinations are negative but clinical suspicion remains high 2
• Patient has prolonged exposure (>6 years) in endemic areas 2
• Loeffler's syndrome or eosinophilia is present without identified pathogen 2

Critical Administration Guidelines

Must Take With Food

Albendazole must be taken with meals to optimize absorption. 4 The tablets may be crushed or chewed and swallowed with water if needed 4.

Mandatory Concomitant Therapy for Neurocysticercosis

Patients treated for neurocysticercosis must receive concomitant steroid and anticonvulsant therapy to prevent neurological complications from inflammatory reactions caused by parasite death. 1, 4 Oral or intravenous corticosteroids should be considered during the first week of treatment to prevent cerebral hypertensive episodes 4.

Pediatric Dosing

• Children >24 months: Same 400 mg single dose for common intestinal parasites 1
• Children 12-24 months: Consult specialist before treatment 1, 2
• Weight-based dosing for tissue parasites: 15 mg/kg/day divided twice daily (maximum 800 mg/day) for patients <60 kg 4
• Microsporidiosis in children: 7.5 mg/kg (maximum 400 mg/dose) twice daily 1

Essential Safety Monitoring

Before Treatment

• Obtain pregnancy test in females of reproductive potential (albendazole is teratogenic) 4
• Exclude Loa loa infection in people from endemic regions BEFORE administering ivermectin (risk of severe encephalopathy) 1, 3
• Baseline complete blood count and liver enzymes 4

During Treatment

• Monitor blood counts at the beginning of each 28-day cycle and every 2 weeks during therapy 2, 4
• Monitor liver enzymes at the beginning of each 28-day cycle and at least every 2 weeks during treatment 4
• Discontinue if clinically significant decreases in blood cell counts occur 4

Common Pitfalls to Avoid

• Never use ivermectin without excluding Loa loa in patients from endemic West/Central Africa (can cause fatal encephalopathy) 1, 3
• Do not use praziquantel for T. solium intestinal infection unless neurocysticercosis has been excluded (niclosamide is preferred) 1
• For schistosomiasis, repeat treatment at 8 weeks as eggs and immature forms are resistant to initial treatment 1, 3
• Use caution with steroids if strongyloidiasis is suspected as they may precipitate hyperinfection syndrome 3
• Advise females of reproductive potential to use effective contraception during treatment and for 3 days after the final dose 4