What is the recommended treatment and dosage of albendazole for worm infestations?

Albendazole Treatment for Worm Infestations

Standard Dosing for Common Intestinal Parasites

For most common intestinal worm infections, albendazole 400 mg as a single oral dose is the recommended treatment, with specific parasites requiring repeat dosing or extended regimens. 1

Single-Dose Regimens (400 mg)

• Ascariasis (roundworm): 400 mg single dose achieves 95-100% cure rates 1, 2, 3
• Hookworm (Ancylostoma duodenale/Necator americanus): 400 mg single dose, repeat in 2 weeks for optimal efficacy 1, 4
• Pinworm (Enterobius vermicularis): 400 mg single dose (alternative: mebendazole 100 mg) 1
• Tapeworm (Taenia spp.): 400 mg single dose when neurocysticercosis is excluded 1

Extended Regimens

• Trichinellosis (mild disease): 400 mg once daily for 3 days 1
• Trichinellosis (severe disease): 400 mg twice daily for 8-14 days 1
• Whipworm (Trichuris trichiura): Single 400 mg dose has limited efficacy (27-48% cure rate); triple-dose regimen (400 mg daily for 3 consecutive days) significantly improves outcomes 2, 5, 6

Specialized Infections Requiring Higher or Prolonged Dosing

Tissue Parasites

• Neurocysticercosis: 400 mg twice daily (or 15 mg/kg/day in divided doses if <60 kg, maximum 800 mg/day) for 8-30 days with concurrent corticosteroids and anticonvulsants 7
• Hydatid disease (Echinococcus granulosus): 400 mg twice daily (or 15 mg/kg/day in divided doses if <60 kg, maximum 800 mg/day) for 28-day cycles, followed by 14-day drug-free intervals, for total of 3 cycles 7
• Echinococcosis (small cysts <5 cm): 400 mg twice daily, duration determined by cyst type 1

Difficult-to-Treat Nematodes

• Strongyloidiasis (normal immunity): Ivermectin 200 μg/kg is preferred; albendazole 400 mg twice daily for 3-7 days is alternative 8
• Strongyloidiasis (immunocompromised): Requires intensive regimens; seek specialist advice 1
• Loiasis (high microfilarial loads): 400 mg daily for 10-28 days; may increase to 800 mg daily if treatment fails 8
• Visceral larva migrans (Toxocariasis): 400 mg twice daily for 5 days 8

Empirical Treatment for Asymptomatic Eosinophilia

For travelers/migrants from endemic areas with eosinophilia and negative stool microscopy, give albendazole 400 mg plus ivermectin 200 μg/kg as a single combined dose to cover possible prepatent geohelminth infections (age >24 months). 1, 8, 4

Critical Safety Precaution

Always exclude Loa loa infection BEFORE administering ivermectin in anyone who has traveled to endemic regions (Central/West Africa), as co-administration can cause severe encephalopathy. 1, 9

Pediatric Dosing

• Children >24 months: Same as adult dosing (400 mg) for standard infections 1, 9
• Children 12-24 months: Consult specialist before treatment 1, 9
• Children <60 kg requiring extended therapy: 15 mg/kg/day in divided doses twice daily (maximum 800 mg/day) 7

Administration Guidelines

• Take with food to enhance absorption 7
• Tablets may be crushed or chewed and swallowed with water 7
• For schistosomiasis co-infection: Repeat treatment at 8 weeks as eggs and immature stages are relatively resistant to initial treatment 1

Monitoring Requirements

Before Treatment

• Obtain pregnancy test in females of reproductive potential (albendazole is teratogenic) 7
• Baseline complete blood count and liver enzymes 7

During Extended Treatment (>14 days)

• Monitor blood counts every 2 weeks for bone marrow suppression, aplastic anemia, agranulocytosis 7
• Monitor liver enzymes (transaminases) every 2 weeks 7
• Discontinue if clinically significant decreases in blood cell counts occur 7

Common Pitfalls to Avoid

• Do not use praziquantel for T. solium intestinal infection unless neurocysticercosis has been definitively excluded, as killing intestinal worms may release viable eggs that can cause neurocysticercosis 1
• Do not administer corticosteroids before excluding Strongyloides infection, as this can precipitate fatal hyperinfection syndrome 9
• For hookworm, single-dose albendazole has moderate efficacy (69-78% cure rate); the repeat dose at 2 weeks is essential for optimal outcomes 4, 10, 2
• Recent evidence suggests 800 mg single dose for hookworm in adults achieves 94% cure rates and is well-tolerated, though this is not yet standard guideline recommendation 10
• Albendazole has poor efficacy against Trichuris with single dosing (27-48% cure rate); consider triple-dose regimen or combination with ivermectin for improved outcomes 2, 5, 6