What is the recommended dose of albendazole (anti-parasitic medication) for empirical deworming?

Albendazole Dosing for Empirical Deworming

For empirical deworming in adults and children over 24 months, give a single dose of albendazole 400 mg orally, combined with ivermectin 200 μg/kg, to cover the most common soil-transmitted helminths including hookworm, ascariasis, and strongyloidiasis. 1, 2

Standard Empirical Deworming Regimen

• Single dose albendazole 400 mg plus ivermectin 200 μg/kg is the recommended empirical treatment for asymptomatic eosinophilia or suspected geohelminth infection when stool microscopy is negative or unavailable 1, 2
• This combination targets prepatent or undetected infections including ascariasis, hookworm, and strongyloidiasis that may not yet be shedding eggs in stool 1
• The albendazole component alone provides excellent coverage against Ascaris lumbricoides (95% cure rate), hookworm (78% overall cure rate), and pinworm (98% cure rate) 3

Age-Specific Considerations

• For children aged 12-24 months with suspected parasitic infection, consult with an expert before initiating empirical treatment 1
• The standard 400 mg dose applies uniformly to all individuals over 24 months regardless of body weight for single-dose empirical treatment 1, 2, 4
• For children under 60 kg requiring prolonged treatment courses (not empirical single-dose), use 15 mg/kg/day divided twice daily with a maximum of 800 mg/day 5

Critical Safety Precaution

• Always exclude Loa loa infection in people who have traveled to endemic regions (Central/West Africa) BEFORE administering ivermectin, as it can cause severe encephalopathy in patients with high Loa loa microfilarial loads 1, 2
• If Loa loa cannot be excluded, consider albendazole 400 mg alone without ivermectin 1

Administration Guidelines

• Albendazole should be taken with food to enhance absorption 5
• Tablets may be crushed or chewed if needed for ease of administration 5
• For females of reproductive potential, obtain a pregnancy test before treatment and advise effective contraception during treatment and for 3 days after, as albendazole is teratogenic 5

When to Consider Repeat Dosing

• For pinworm (Enterobius vermicularis), repeat the 400 mg dose in 2 weeks to eradicate newly hatched worms 2, 4
• For hookworm requiring complete eradication (not just empirical treatment), give albendazole 400 mg daily for 3 days 2
• For schistosomiasis concerns, repeat treatment at 8 weeks as eggs and immature schistosomulae are relatively resistant to initial treatment 1

Common Pitfalls to Avoid

• Do not use the empirical single-dose regimen for confirmed strongyloidiasis in immunocompromised patients—these require prolonged treatment courses with ivermectin 200 μg/kg on days 1,2,15, and 16 1
• Do not assume negative stool microscopy rules out infection—standard 3-stool examination misses many infections, particularly in early or light infections 6
• Do not give ivermectin without first excluding Loa loa in travelers from endemic areas 1, 2
• Monitor blood counts and liver enzymes if treatment extends beyond 14 days, as prolonged albendazole can cause bone marrow suppression and hepatotoxicity 5

Adverse Events

• Albendazole has a remarkable safety profile with gastrointestinal side effects (nausea, vomiting, abdominal pain, diarrhea) occurring in just over 1% of patients with single-dose treatment 3
• Headache and fever may occur but are generally mild and self-limited 3
• Serious adverse events including bone marrow suppression are rare with single-dose treatment but warrant monitoring with prolonged courses 5