Empirical Deworming Regimen for Adults
For empirical deworming in adults, the recommended regimen is a single dose of albendazole 400 mg orally, repeated in 2 weeks, which provides broad-spectrum coverage against the most common intestinal helminths. 1
First-Line Empirical Treatment
- Albendazole 400 mg as a single oral dose, with a repeat dose in 2 weeks is the standard empirical treatment for adults with suspected helminth infections 1, 2
- This regimen effectively treats hookworm (both Ancylostoma duodenale and Necator americanus), roundworm (Ascaris lumbricoides), and pinworm (Enterobius vermicularis) 1, 2
- Administration with a fatty meal (approximately 40 grams of fat) increases albendazole absorption up to 5-fold, significantly improving efficacy 3
Enhanced Empirical Regimen for High-Risk Populations
For adults with prolonged exposure in endemic areas (especially travelers or migrants) with suspected but undetected parasitic infections, consider combination therapy: albendazole 400 mg plus ivermectin 200 μg/kg as a single dose. 1, 2
- This combination provides broader coverage including Strongyloides stercoralis, which can cause life-threatening hyperinfection syndrome in immunocompromised patients 1
- The ivermectin dose is approximately 12 mg for a 60 kg adult or 6 mg for a 30 kg patient 1
- Critical caveat: Always exclude Loa loa infection before administering ivermectin in patients who have traveled to endemic regions (Central/West Africa), as treatment can precipitate severe encephalopathy 2
Efficacy by Parasite Species
High Efficacy (Single-Dose Albendazole 400 mg):
- Roundworm (Ascaris lumbricoides): 95% cure rate, >99.9% egg reduction rate 4
- Pinworm (Enterobius vermicularis): 98% cure rate 4
- Hookworm: 78% overall cure rate (92% for A. duodenale, 75% for N. americanus) 4
Moderate Efficacy (Requires Extended or Combination Therapy):
- Whipworm (Trichuris trichiura): Only 48% cure rate with single-dose albendazole 4
- For suspected whipworm, consider triple-dose regimen: albendazole 400 mg daily for 3 consecutive days, which improves cure rates 5, 2
- Alternatively, the combination of albendazole 400 mg plus ivermectin 200 μg/kg achieves 75% cure rate for Trichuris 6
Alternative Regimen: Mebendazole
- Mebendazole 100 mg as a single dose, repeated in 2 weeks is an acceptable alternative for pinworm 7, 8
- However, albendazole is superior to mebendazole for hookworm (69% vs 29% cure rate with single dose; 92% vs 54% with triple dose) 5
- For empirical treatment where hookworm is likely, albendazole is strongly preferred over mebendazole 5
Clinical Scenarios Requiring Modified Dosing
Extended Treatment for Specific Parasites:
- Hookworm (complete eradication): Albendazole 400 mg daily for 3 consecutive days 2
- Strongyloidiasis: Ivermectin 200 μg/kg single dose is preferred; albendazole 400 mg twice daily for 3-7 days is an alternative 2
- Whipworm: Albendazole 400 mg daily for 3 days or combination with ivermectin 2, 6
Higher Doses for Resistant Infections:
- Recent evidence suggests albendazole 800 mg as a single dose may provide superior efficacy in adults with hookworm (94% cure rate vs 75% with 400 mg) 9
- This higher dose is well-tolerated with only 10.7% reporting any adverse events at 3 hours post-treatment 9
- Consider 800 mg dosing for treatment failures or in areas with suspected drug resistance 9
Follow-Up and Monitoring
- Repeat stool examination 2-3 weeks after treatment if symptoms persist 1
- For persistent infections despite appropriate treatment, consider alternative diagnoses or resistant infection 1
- Retreatment 1 month after symptom resolution may be needed to ensure adult worms are eliminated 1
- If treatment extends beyond 14 days, monitor for hepatotoxicity and leukopenia 1
Important Clinical Pitfalls to Avoid
- Do not skip the repeat dose at 2 weeks: The second dose is essential to eradicate newly hatched worms from eggs that survived the initial treatment 1, 7
- Screen for Loa loa before ivermectin: Failure to do so can result in severe neurological complications 2
- Ensure fatty meal co-administration: Fasting significantly reduces albendazole absorption and efficacy 3
- Consider household contact screening: In endemic settings, treat household contacts to prevent reinfection 1
- Emphasize preventive measures: Hand hygiene and wearing shoes in endemic areas are essential to prevent reinfection 1