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

Albendazole Deworming Guidelines

Standard Single-Dose Regimen

For most common intestinal parasitic infections (roundworm, pinworm, and initial hookworm treatment), albendazole 400 mg as a single oral dose is the recommended treatment. 1, 2

Specific Single-Dose Indications:

• Ascaris lumbricoides (roundworm): 400 mg single dose 1, 2
• Enterobius vermicularis (pinworm): 400 mg single dose, repeat in 2 weeks 1, 3
• Hookworm (initial treatment): 400 mg single dose 1, 2

Administration Guidelines:

• Albendazole tablets should be taken with food to enhance absorption 4
• Tablets may be crushed or chewed and swallowed with water 4

Multi-Day Regimens for Specific Infections

Hookworm (Complete Treatment):

Albendazole 400 mg once daily for 3 consecutive days is recommended for diagnosed hookworm infections to achieve superior cure rates. 1, 5

• This 3-day regimen is particularly important for heavy infections that can cause significant anemia in young children 5
• Single-dose therapy achieves only 75-78% cure rates for Necator americanus, while multi-day regimens improve outcomes 6

Strongyloidiasis:

• Normal immunity: Albendazole 400 mg twice daily for 3-7 days (ivermectin is preferred) 1, 2
• Immunocompromised patients: More intensive regimens required; seek specialist advice 1, 2

Trichinellosis:

• Mild disease: Albendazole 400 mg once daily for 3 days 1
• Severe disease: Albendazole 400 mg twice daily for 8-14 days 1

Visceral Larva Migrans (Toxocariasis):

• Albendazole 400 mg twice daily for 5 days 1, 2
• Add prednisolone 40-60 mg once daily in severe disease 1

Pediatric Dosing

Weight-Based Dosing:

• Children ≥60 kg: Use adult dosing (400 mg) 4
• Children <60 kg: 15 mg/kg/day divided twice daily (maximum 800 mg/day total) for conditions requiring multi-day therapy 4

Age-Specific Considerations:

• Children ≥2 years: Standard 400 mg single dose for common parasites 2, 3
• Children 12-24 months: Consult specialist before treatment 2
• The 400 mg single dose for pinworm applies to all ages, including 2-year-olds 3

Empirical Treatment for Asymptomatic Eosinophilia

For travelers/migrants with unexplained eosinophilia, give albendazole 400 mg single dose plus ivermectin 200 μg/kg single dose. 1, 2

• Critical caveat: Always exclude Loa loa infection in people who traveled to endemic regions BEFORE administering ivermectin 1, 2
• Consider retreatment 1 month after resolution of symptoms to ensure adult worms are treated 1

Special Situations Requiring Higher or Prolonged Dosing

Microsporidiosis (HIV/Immunocompromised):

• Albendazole 7.5 mg/kg twice daily (maximum 400 mg/dose) until immune reconstitution 1, 2
• More effective for Encephalitozoon intestinalis than Enterocytozoon bieneusi 1

Loiasis:

• Albendazole 400 mg daily for 10-28 days for high microfilarial loads 1, 2
• May increase to 800 mg daily if treatment fails 1, 2

Hydatid Disease (Echinococcosis):

• Patients ≥60 kg: 400 mg twice daily with meals 4
• Patients <60 kg: 15 mg/kg/day divided twice daily (maximum 800 mg/day) 4
• Duration: 28-day cycles followed by 14-day drug-free intervals, for total of 3 cycles 4

Neurocysticercosis:

• Patients ≥60 kg: 400 mg twice daily with meals for 8-30 days 4
• Patients <60 kg: 15 mg/kg/day divided twice daily (maximum 800 mg/day) 4
• Mandatory concomitant therapy: Oral or IV corticosteroids to prevent cerebral hypertensive episodes during first week 4
• Add anticonvulsant therapy as required 4

Critical Safety Monitoring

Before Treatment:

• Obtain pregnancy test in females of reproductive potential 4
• Baseline complete blood count 4
• Baseline liver enzymes (transaminases) 4

During Multi-Day or Cyclic Therapy:

• Monitor blood counts every 2 weeks while on therapy 4
• Monitor liver enzymes at least every 2 weeks during treatment 4
• Patients with liver disease or hepatic echinococcosis require more frequent monitoring due to increased risk of bone marrow suppression 4
• Discontinue albendazole if clinically significant decreases in blood cell counts occur 4

Important Clinical Pitfalls to Avoid

Contraindications and Warnings:

• Pregnancy: Albendazole causes embryotoxicity and skeletal malformations in animal studies 4
• Advise females of reproductive potential to use effective contraception during treatment and for 3 days after final dose 4
• Contraindicated in patients with known hypersensitivity to benzimidazole compounds 4

Infection-Specific Cautions:

• Do NOT use single-dose therapy for diagnosed hookworm—the 3-day regimen is necessary for adequate cure rates 1, 5
• For Taenia solium (pork tapeworm): Use niclosamide instead of praziquantel unless neurocysticercosis has been excluded 1, 2
• Avoid steroids in suspected strongyloidiasis until infection is excluded, as steroids can cause hyperinfection syndrome 1
• For schistosomiasis: Repeat treatment at 8 weeks as eggs and immature schistosomulae are resistant to initial treatment 1

Treatment Failure Considerations:

• Persistent symptoms after pinworm treatment usually indicate reinfection rather than medication resistance 3
• Assess for anemia in all hookworm patients, particularly children and those with heavy infections 5
• Consider co-infections, as hookworm commonly coexists with other soil-transmitted helminths 5

Efficacy Limitations:

• Albendazole has poor efficacy against Trichuris trichiura (whipworm) with cure rates of only 48% at standard dosing 6
• Single-dose albendazole may not adequately clear Ascaris lumbricoides in some populations, with reinfection rates returning to baseline by 12-16 weeks 7