What is the World Health Organization (WHO) recommendation for albendazole (albendazole) treatment?

WHO Recommendations for Albendazole

Primary Recommendation

The World Health Organization recommends albendazole 400 mg orally once daily for 3 consecutive days as the standard treatment for hookworm infections, particularly in cases of heavy or chronic infections. 1

Specific Indications and Dosing

Soil-Transmitted Helminths

• Hookworm infection: Albendazole 400 mg once daily for 3 consecutive days is the WHO-recommended regimen, with all household members receiving treatment simultaneously to prevent reinfection 1

• Ascaris lumbricoides: Single-dose albendazole 400 mg achieves cure rates of 88% (95% CI, 79%-93%), making it highly effective for roundworm infection 2

• Trichuris trichiura (whipworm): Single-dose albendazole shows poor efficacy with only 28% cure rate (95% CI, 13%-39%), requiring extended regimens 2

Tissue Parasites

• Cystic echinococcosis (hydatid disease):

  • For cysts <5 cm: Albendazole 400 mg twice daily alone 3
  • For cysts ≥5 cm requiring PAIR procedure: Albendazole 400 mg twice daily plus praziquantel 20 mg/kg twice daily for 2 weeks pre- and post-procedure 3
  • Duration determined by cyst type and stage per WHO IWGE classification 3

• Alveolar echinococcosis: Albendazole is first-line treatment, with duration depending on staging; lifelong therapy may be required if curative resection cannot be performed 3

• Neurocysticercosis: Albendazole 15 mg/kg/day (up to 1200 mg/day) for variable duration depending on cyst location and type 3

• Trichinellosis: Albendazole 400 mg once daily for 3 days in mild disease 3

Critical Monitoring Requirements

For treatment courses exceeding 14 days, monitor for hepatotoxicity and leukopenia. 3

• Elevated liver enzymes occur in up to 16% of patients on chronic therapy, requiring drug discontinuation in 3.8% 3
• Leukopenia develops in up to 10% of patients 3
• Transaminases normalize in almost all cases when albendazole is discontinued promptly 3

Important Clinical Considerations

Absorption Enhancement

• Albendazole is poorly absorbed; administration with fatty meals significantly improves bioavailability 3

Treatment-Related Adverse Effects

• Headaches, seizures, and dizziness result from parasiticidal activity and treatment-induced inflammation rather than direct drug toxicity 3
• Transient increase in seizure frequency occurs after therapy for neurocysticercosis 3

Combination Therapy

• No additional monitoring beyond standard albendazole protocols is needed when combining albendazole with praziquantel 3
• For persistent Trichuris infection after initial albendazole failure, combination therapy with albendazole 400 mg plus ivermectin 600 μg increases cure rate to 75.2% (95% CI: 67.3-83.2%) 4

Common Pitfalls

• Single-dose limitations: While convenient for mass drug administration programs, single-dose albendazole 400 mg shows only moderate efficacy against hookworm (72% cure rate) and poor efficacy against Trichuris (28% cure rate) 2

• Species-specific efficacy: Albendazole efficacy varies dramatically by helminth species; assuming uniform effectiveness across all soil-transmitted helminths leads to treatment failures 5, 2

• Inadequate duration for tissue parasites: Echinococcosis and neurocysticercosis require prolonged courses (weeks to months or lifelong), not the 1-3 day regimens used for intestinal helminths 3

• Failure to treat household contacts: For hookworm, simultaneous treatment of all household members is essential to prevent reinfection 1