What is the treatment for intestinal parasitism in children?

Treatment of Intestinal Parasitism in Children

For most common intestinal worms in children, treat with albendazole 400 mg as a single oral dose or mebendazole 100 mg twice daily for 3 days, with specific dosing adjustments based on the parasite identified. 1

First-Line Treatment by Parasite Type

Common Roundworm (Ascaris lumbricoides)

• Albendazole 400 mg single dose is highly effective with cure rates exceeding 93% 2
• Alternative: Mebendazole 100 mg twice daily for 3 days 3, 2
• Both regimens show equivalent efficacy with egg reduction rates of 96-100% 2

Hookworm (Ancylostoma duodenale/Necator americanus)

• Albendazole 400 mg daily for 3 days (extended course for hookworm) 4
• Alternative: Mebendazole 100 mg twice daily for 3 days 3
• Critical in young children due to risk of anemia 4

Whipworm (Trichuris trichiura)

• Mebendazole 100 mg twice daily in combination with ivermectin 200 μg/kg once daily for 3 days 4
• Combination therapy improves cure rates in heavy infections where single-agent mebendazole shows lower efficacy 4

Pinworm (Enterobius vermicularis)

• Albendazole 400 mg single dose or mebendazole 100 mg single dose 4, 3
• Treat all household members simultaneously to prevent reinfection 5
• Repeat dose in 2 weeks to eliminate newly hatched worms 5

Tapeworms

• Taenia saginata/solium: Praziquantel 10 mg/kg single dose 4, 1
• Hymenolepis nana (dwarf tapeworm): Praziquantel 25 mg/kg single dose 4, 1
• If Taenia solium identified, obtain cysticercosis serology to rule out neurocysticercosis before treatment 4

Protozoal Infections

Giardia lamblia

• Nitazoxanide: 100 mg twice daily for children 1-3 years; 200 mg twice daily for children 4-11 years for 3 days 4
• Alternative: Metronidazole 5
• Nitazoxanide shows 88% clinical response in HIV-uninfected children 4

Cryptosporidium

• Nitazoxanide at age-appropriate dosing (same as above) for 3 days 4
• Supportive care with hydration and electrolyte correction is essential 4
• In HIV-infected children with CD4 >50/µL, nitazoxanide may be effective, but shows limited benefit with CD4 <50/µL 4
• Use antimotility agents with extreme caution in young children 4

Cyclospora cayetanensis

• Trimethoprim-sulfamethoxazole 960 mg twice daily for 7 days (dose adjusted for weight in children) 5

Broad-Spectrum Approach for Mixed Infections

Nitazoxanide demonstrates efficacy against both protozoa (84% elimination) and helminths (95% elimination) in mixed infections, making it valuable when multiple parasites are suspected 6

Critical Management Considerations

No Special Preparation Required

• Fasting or purging is unnecessary before treatment 3
• Tablets may be chewed, swallowed, or crushed and mixed with food 3

Treatment Regardless of Symptoms

• Treat all confirmed infections even in asymptomatic children to prevent transmission and complications 1

Follow-Up Protocol

• If not cured at 3 weeks post-treatment, administer a second course 3
• Repeat stool examination 2-3 weeks after treatment for persistent symptoms 1
• Submit at least 3 stool samples for diagnosis when parasites shed intermittently (e.g., Cryptosporidium) 4

Prevention Measures

• Emphasize hand and fingernail hygiene with soap 1
• Ensure adequate hydration, especially with diarrheal symptoms 1

Safety Profile

Adverse events with albendazole, mebendazole, and ivermectin are generally mild and similar across agents, including nausea, vomiting, abdominal pain, diarrhea, headache, and fever 2. Nitazoxanide is well-tolerated with no serious adverse effects reported in pediatric studies 4, 6.

Common Pitfalls to Avoid

• Do not use single-dose mebendazole for whipworm—it requires combination therapy with ivermectin for adequate cure rates 4
• Do not overlook neurocysticercosis screening when Taenia solium is identified or species is uncertain 4
• Do not rely on single stool sample for parasites with intermittent shedding 4
• Avoid antimotility agents in young children with protozoal diarrhea due to safety concerns 4