Management of Ascariasis on a Psychiatric Unit
Treat ascariasis with a single dose of albendazole 400 mg, mebendazole 500 mg, or ivermectin 200 μg/kg, and implement standard enteric precautions to prevent fecal-oral transmission among other patients and staff. 1
Treatment Approach
The 2025 UK guidelines provide clear, evidence-based treatment options for ascariasis that are straightforward to implement in a psychiatric unit setting 1:
- Albendazole 400 mg PO as a single dose (preferred option) 1
- Mebendazole 500 mg PO as a single dose (alternative) 1
- Ivermectin 200 μg/kg PO as a single dose (alternative) 1
All three regimens demonstrate excellent efficacy with cure rates exceeding 90% and are equally effective 2. The single-dose regimen is particularly advantageous in psychiatric settings where medication adherence may be challenging. No fasting or purging is required before treatment 3.
Critical Precautions for the Psychiatric Unit
Infection Control Measures
Standard enteric precautions must be implemented immediately given the fecal-oral transmission route 1:
- Ensure proper hand hygiene after toileting and before meals
- Monitor bathroom facilities for cleanliness
- Consider temporary isolation or cohorting if multiple cases occur
- Educate staff about transmission risks
Monitoring for Complications
While most ascariasis cases are asymptomatic, be vigilant for serious complications that require urgent intervention 1, 4:
- Gastrointestinal obstruction (especially in children with heavy worm burden) 1, 4
- Biliary obstruction (more common in adults) 1
- Intestinal perforation (rare but life-threatening) 4
- Worm migration - patients may pass or regurgitate visible earthworm-sized worms 1
Red flags requiring immediate surgical consultation: acute abdominal pain, distension, vomiting, or signs of peritonitis 4.
Drug Interactions and Psychiatric Medications
Albendazole should be monitored for hepatotoxicity if treatment extends beyond 14 days, though this is not relevant for single-dose ascariasis treatment 1. The anthelmintic drugs used for ascariasis have minimal interactions with psychiatric medications and can be safely administered 1.
Special Considerations for Psychiatric Patients
If Corticosteroids Are Anticipated
Before initiating any corticosteroid therapy (which may be needed for psychiatric or medical conditions), screen or empirically treat for Strongyloides stercoralis to prevent hyperinfection syndrome 1. While this guideline addresses neurocysticercosis, the principle applies broadly to any patient requiring immunosuppression.
Medication Administration
The tablet may be chewed, swallowed, or crushed and mixed with food 3, which is helpful for patients with swallowing difficulties or medication refusal. Direct observation of therapy is recommended to ensure compliance.
Follow-Up
Re-evaluate at 3 weeks post-treatment if symptoms persist or worms continue to be passed 3. A second course of treatment may be indicated if cure is not achieved 3. However, given the high cure rates (>90%) with single-dose therapy, treatment failure is uncommon 2.
Common Pitfalls to Avoid
- Do not delay treatment - single-dose therapy is highly effective and well-tolerated 1, 2
- Do not overlook infection control - the fecal-oral transmission route poses risk to other patients and staff in congregate settings 1
- Do not assume all abdominal symptoms are psychiatric - ascariasis can cause genuine surgical emergencies 4
- Do not use multiple-dose regimens unnecessarily - single-dose therapy is equally effective and improves adherence 2
Safety Profile
Adverse events are minimal and similar across all three anthelmintic options 2. The most commonly reported side effects include nausea, vomiting, abdominal pain, diarrhea, headache, and fever, but these are generally mild and self-limited 2.