Treatment of Pinworms (Enterobiasis)
The recommended treatment for pinworm infection is a single oral dose of either albendazole 400 mg or mebendazole 100 mg, repeated in 2 weeks, with the same dosing for both children and adults. 1, 2
First-Line Medication Options
Albendazole and mebendazole are equally effective and represent the drugs of choice for pinworm treatment:
- Albendazole 400 mg as a single oral dose is recommended by the American Academy of Pediatrics, with a repeat dose in 2 weeks 1
- Mebendazole 100 mg as a single oral dose is FDA-approved with a 95% cure rate for pinworm, repeated in 2 weeks 2
- Both medications are standardized across all age groups, including young children as young as 2 years old 1
- The tablet may be chewed, swallowed, or crushed and mixed with food 2
Alternative option:
- Pyrantel pamoate 11 mg/kg (maximum 1 g) as a single dose, repeated in 2 weeks, is an alternative particularly preferred in pregnant women 3, 4
Critical Treatment Considerations
The 2-week repeat dose is essential because:
- Mebendazole and albendazole are both adulticidal and ovicidal, but the repeat dose eradicates any newly hatched worms from eggs that survived the initial treatment 3
- Pyrantel pamoate is only adulticidal (not ovicidal), making the repeat dose even more critical with this agent 3
Household and Contact Management
Treatment of all household members should be strongly considered, especially when:
- Multiple symptomatic infections occur 3
- Repeated infections are documented 4
- This approach is a prerequisite to lasting success of treatment 4
When to Retreat Beyond Standard Protocol
For recurrent infections despite standard treatment:
- Consider prolonged "pulse scheme" treatment for up to 16 weeks 4
- Recurrences are common due to repeated cycles of reinfection and autoinfection, not treatment failure 3
- If not cured three weeks after treatment, a second full course is advised 2
Clinical Presentation to Recognize
The most common symptom is nocturnal perianal itching, though 30-40% of infected children are asymptomatic 1, 3
Other symptoms include:
- Weight loss, irritability, diarrhea, and abdominal pain 1
- In girls, vaginal discharge from female genital tract colonization 1
- Scratching may cause skin irritation, eczematous dermatitis, or secondary bacterial infections 5
Diagnostic Confirmation
The cellophane tape test is the preferred diagnostic method:
- Apply the sticky side of tape to perianal skin in the morning before bathing or bowel movements 1
- A single test has only 50% sensitivity, but three tests performed on different mornings increases sensitivity to approximately 90% 3
- Pinworms and eggs are not usually passed in stool, so stool examination is not recommended 1, 3
Essential Hygiene Measures
No special procedures like fasting or purging are required, but preventive hygiene is critical:
- Frequent handwashing, especially after bowel movements and before meals 3
- Clipping fingernails short 3
- Avoiding finger-sucking, nail-biting, and scratching in the anogenital area 3
- These measures are essential to prevent the short reinfection cycle given the brief life span of adult pinworms 3
Common Pitfall to Avoid
Do not assume treatment failure when recurrence happens—this is usually reinfection or autoinfection, not drug resistance 3. The key is combining medication with strict hygiene measures and treating all household contacts simultaneously 4.