How to control intestinal parasites?

How to Control Intestinal Parasites

The control of intestinal parasites requires specific anthelminthic therapy based on the identified organism, combined with preventive measures targeting transmission routes. 1

Diagnostic Approach

Diagnosis must be established before treatment through concentrated stool microscopy, fecal PCR, or organism-specific tests. 1 Key diagnostic methods include:

• Concentrated stool microscopy is the first-line diagnostic test for most helminthic infections 1
• Fecal PCR offers higher sensitivity when available 1
• Sellotape/paddle test for pinworm diagnosis by collecting perianal specimens 1
• At least 3 stool specimens should be examined over time, as parasite excretion can be intermittent 2

Treatment by Specific Parasite

Roundworm (Ascaris lumbricoides)

• Albendazole 400 mg PO as a single dose is first-line treatment 1, 3
• Alternative options: mebendazole 500 mg single dose or ivermectin 200 μg/kg single dose 3

Hookworm (Ancylostoma/Necator)

• Albendazole 400 mg PO daily for 3 days is recommended 1, 4
• Alternative: mebendazole 500 mg single dose or ivermectin 200 μg/kg single dose 4
• Iron supplementation is essential in patients with heavy infections causing anemia 4

Pinworm (Enterobius vermicularis)

• Albendazole 400 mg PO as a single dose 1
• Alternative: mebendazole 100 mg single dose 1
• Treat all household members simultaneously to prevent reinfection 5

Whipworm (Trichuris trichiura)

• Mebendazole 100 mg PO twice daily PLUS ivermectin 200 μg/kg once daily for 3 days 1
• Combination therapy improves cure rates in heavy infections 1

Tapeworms (Taenia species)

• Praziquantel 10 mg/kg PO as a single dose for T. saginata and T. solium 1
• Critical caveat: If T. solium is identified or species unknown, obtain cysticercosis serology to rule out neurocysticercosis, which requires steroids plus albendazole 1

Dwarf Tapeworm (Hymenolepis nana)

• Praziquantel 25 mg/kg PO as a single dose (higher dose than other tapeworms) 1

Threadworm (Strongyloides stercoralis)

• Ivermectin is the treatment of choice for strongyloidiasis 2
• In severe hyperinfestation syndrome: Prednisolone 40-60 mg once daily plus albendazole; intensive care may be needed 1
• Monitor for recrudescence: Perform at least 3 stool examinations over 3 months post-treatment, as larvae can reappear up to 106 days later 2

Prevention and Control Measures

Personal Hygiene

• Handwashing with soap frequently, especially before eating and after toilet use 5
• Wear shoes in endemic areas to prevent hookworm penetration through skin 4, 6
• Daily underwear changes and wearing tight underpants for pinworm prevention 5

Environmental Control

• Proper sewage disposal is critical for preventing hookworm, roundworm, and whipworm transmission 6
• Vacuum or damp mop floors for several days after pinworm treatment; avoid dry sweeping 5
• Wash bed linens and nightclothes after treatment without shaking them 5

Food and Water Safety

• Consume bottled water in endemic areas 6
• Thoroughly wash or cook all fruits and vegetables 5
• Avoid raw or undercooked meat to prevent tapeworm and Trichinella infection 1

Mass Treatment Considerations

Mass chemoprophylaxis is NOT recommended for most intestinal parasites as it diverts resources from more effective control measures 1. However:

• Targeted treatment of household contacts is appropriate in endemic settings 4
• Screen and treat close contacts when index cases are identified 4

Common Pitfalls to Avoid

• Do not assume single stool test rules out infection: Parasite shedding is intermittent; obtain multiple specimens 2
• Do not use standard hookworm doses for H. nana: This tapeworm requires 25 mg/kg praziquantel, not 10 mg/kg 1
• Do not forget iron supplementation: Hookworm causes significant blood loss requiring iron replacement 4
• Do not overlook neurocysticercosis risk: Always consider cysticercosis serology with T. solium or unidentified tapeworm species 1
• Do not stop monitoring after treatment: Strongyloides requires 3-month follow-up due to potential recrudescence 2