Medication for Ascariasis
The recommended first-line treatment for ascariasis is a single oral dose of either albendazole 400 mg, mebendazole 500 mg, or ivermectin 200 μg/kg, all of which achieve cure rates exceeding 95%. 1
Primary Treatment Options
All three first-line agents demonstrate equivalent efficacy with no clinically significant differences detected between them:
- Albendazole 400 mg as a single oral dose is highly effective with cure rates of 98% and egg reduction rates of 99% 1, 2
- Mebendazole 500 mg as a single oral dose achieves similar cure rates exceeding 95% with egg reduction rates of 99% 1, 3, 2
- Ivermectin 200 μg/kg as a single oral dose demonstrates comparable efficacy to albendazole and mebendazole 1, 4
Important Dosing Considerations
The FDA-approved mebendazole regimen differs from guideline recommendations: the FDA label indicates 100 mg twice daily for 3 consecutive days for ascariasis, with a 98% cure rate 2. However, the single 500 mg dose recommended by guidelines is more practical for mass treatment programs and achieves equivalent efficacy 1, 3.
Comparative Efficacy Evidence
High-quality systematic review data confirms no meaningful differences between agents 4:
- Single-dose albendazole versus single-dose mebendazole: cure rates 98.0% vs 96.9% (no significant difference) 4
- Single-dose albendazole versus single-dose ivermectin: cure rates 87.8% vs 90.2% (no significant difference) 4
- All agents achieve egg reduction rates of 96-100% within 60 days 4
Safety Profile
All three medications demonstrate excellent safety profiles 4:
- No serious adverse events reported in clinical trials 4
- Minor adverse events (nausea, vomiting, abdominal pain, diarrhea, headache) occur at similar rates across all agents 4
- Safe for use in both children and adults with confirmed infection 4
Special Clinical Scenarios
For Loeffler's syndrome (pulmonary larval migration phase): Treat with albendazole 400 mg or mebendazole 500 mg as a single dose, and consider repeating treatment one month after resolution of pulmonary symptoms 3. Exercise caution with corticosteroid use if Strongyloides coinfection is possible 3.
For intestinal or biliary obstruction: Anthelmintic therapy should be administered, but surgical intervention may be required in addition to medical management 1.
Administration Details
- Tablets may be chewed, swallowed whole, or crushed and mixed with food 2
- No special preparation (fasting or purging) is required 2
- If cure is not achieved three weeks after treatment, a second course is recommended 2
Follow-up
No specific follow-up is typically needed after successful treatment unless symptoms persist 1. Stool microscopy remains the standard diagnostic test for confirming cure when indicated 1.