What is the recommended treatment for patients with intestinal worms?

Treatment of Intestinal Worms

Albendazole 400 mg orally as a single dose is the first-line treatment for most intestinal worm infections, including hookworm, roundworm (Ascaris), and pinworm (Enterobius). 1, 2

Treatment by Specific Helminth

Hookworm (Ancylostoma duodenale, Necator americanus)

• Albendazole 400 mg PO daily for 3 days is the recommended regimen 1
• Alternative: Mebendazole 100 mg twice daily for 3 days 3
• For severe disease with anemia, add prednisolone 40-60 mg once daily 1
• Cure rates: Albendazole achieves 72% cure rate versus only 32% for pyrantel pamoate 4

Roundworm (Ascaris lumbricoides)

• Albendazole 400 mg PO as a single dose 2
• Alternative: Mebendazole 100 mg twice daily for 3 days 2, 3
• Cure rates: Albendazole 88%, ivermectin 100%, mebendazole 98% 3, 4

Pinworm (Enterobius vermicularis)

• Albendazole 400 mg PO as a single dose 2
• Alternative: Mebendazole 100 mg as a single dose, repeated after 2 weeks 3
• Cure rates: Mebendazole 95%, albendazole 94.1%, pyrantel pamoate 96.3% 3, 4
• Treat all household contacts simultaneously due to high contagiousness 2

Whipworm (Trichuris trichiura)

• Mebendazole 100 mg PO twice daily PLUS ivermectin 200 μg/kg once daily for 3 days 1
• This combination is essential because monotherapy has low cure rates in heavy infections 1
• Combination therapy achieves 38-80% cure rates versus lower rates with single agents 4

Threadworm/Strongyloides (Strongyloides stercoralis)

• Albendazole 400 mg PO twice daily for 21 days with monitoring of liver function and complete blood count 1
• Alternative: Ivermectin 200 μg/kg daily for 2 days (cure rates 93-97% versus 63% for albendazole) 4
• Critical caveat: Exclude Loa loa infection before giving ivermectin in patients from endemic regions (Central/West Africa) to prevent severe encephalopathy 2

Tapeworms (Taenia species)

• Praziquantel 10 mg/kg PO as a single dose 2
• Cure rates: 75-85% 4

Dwarf Tapeworm (Hymenolepis nana)

• Praziquantel 25 mg/kg PO as a single dose 1, 2
• Alternative: Niclosamide 2 g once daily for 7 days 1

Empirical Treatment Strategy

For patients from endemic areas with high pretest probability but negative stool tests, give albendazole 400 mg PLUS ivermectin 200 μg/kg as a single combined dose 2, 5. This addresses:

• High false-negative rates of standard stool microscopy 5
• Prepatent infections (worms not yet producing eggs) 2
• Multiple possible coinfections common in endemic regions 2

Critical Monitoring and Precautions

Contraindications

• Do not use albendazole or mebendazole in first trimester of pregnancy 6
• Screen for Loa loa before ivermectin in patients from Central/West Africa 2

When to Seek Specialist Advice

• Immunocompromised patients require modified regimens and specialist consultation 2
• Children aged 12-24 months need expert consultation before empirical treatment 2
• Severe disease requiring intensive care management 1

Side Effects to Monitor

• Liver toxicity with prolonged courses (>14-28 days) of benzimidazoles 7
• Neutropenia/myelosuppression with high-dose albendazole 7
• Generally well-tolerated with few side effects at standard doses 8

Prevention Measures to Prevent Reinfection

• Hand hygiene with soap before eating and after defecation 2, 3
• Wear shoes in endemic areas to prevent hookworm penetration through skin 2, 5
• Treat household contacts for highly contagious infections like pinworm 2, 5
• Clean bedding and underwear after treatment for pinworm 3

Diagnostic Approach

• Concentrated stool microscopy is first-line for most helminths 1, 2
• Fecal PCR offers higher sensitivity when available 1, 2
• For Strongyloides, serology and specialized stool techniques are needed due to low microscopy sensitivity 2