What is the recommended dosing of albendazole (anti-parasitic medication) for pediatric patients?

Albendazole Dosing in Pediatric Patients

For most common intestinal parasitic infections in children, administer albendazole 400 mg as a single oral dose for children over 24 months of age, with the dose adjusted to 15 mg/kg/day (maximum 800 mg/day) divided twice daily for more severe or systemic infections. 1, 2

Standard Dosing by Indication

Common Intestinal Helminths (Single-Dose Regimen)

• Children ≥24 months: 400 mg as a single oral dose for hookworm, ascariasis, and enterobiasis 1
• Efficacy: This achieves cure rates of 78% for hookworm (92% for Ancylostoma duodenale, 75% for Necator americanus), 95% for Ascaris lumbricoides, and 98% for Enterobius vermicularis 3
• Administration: Give with food to improve absorption 2
• Repeat dosing: Consider a second dose 2-8 weeks later for residual infections that mature to adults 1

Infections Requiring Multi-Day Treatment

• Trichuris trichiura (whipworm): 400 mg daily for 3 days achieves 80% cure rate (single doses are inadequate with <30% cure rates) 4
• Strongyloidiasis: 400 mg daily for 3 days 1
• Giardiasis: 400 mg daily for 5 days achieves 95% cure rate (3-day regimen: 81% cure rate) 5
• Taenia species: 400 mg daily for 3 days 6
• Hymenolepis nana: Requires higher dose of praziquantel (25 mg/kg single dose) rather than albendazole 6

Severe/Systemic Infections (Weight-Based Dosing)

For hydatid disease and neurocysticercosis 2:

• Children ≥60 kg: 400 mg twice daily with meals
• Children <60 kg: 15 mg/kg/day divided into two doses with meals (maximum 800 mg/day)
• Duration:
  • Hydatid disease: 28-day cycles with 14-day drug-free intervals, total of 3 cycles
  • Neurocysticercosis: 8-30 days
• Concomitant therapy: Administer corticosteroids during first week to prevent cerebral hypertensive episodes 2

Immunocompromised Patients

• Microsporidiosis: 7.5 mg/kg twice daily until immune reconstitution 7
• This represents a higher dose requirement for opportunistic infections in HIV-infected or severely immunocompromised children 7

Critical Safety Monitoring

For treatment courses >14 days, mandatory monitoring includes 7, 2:

• Complete blood counts at treatment initiation and every 2 weeks (monitor for leukopenia)
• Liver enzymes (transaminases) at treatment initiation and every 2 weeks (monitor for hepatotoxicity)
• Pregnancy testing in adolescent females of reproductive potential before treatment 2

Administration Pearls

• Tablet preparation: Tablets may be crushed or chewed and swallowed with water for young children who cannot swallow whole tablets 2
• Food requirement: Always administer with fatty meals to enhance absorption 7, 2
• Age restrictions: For children 12-24 months with asymptomatic eosinophilia, seek expert consultation before empirical treatment 1

Common Pitfalls to Avoid

• Underdosing Trichuris: Single 400 mg doses achieve only 27-48% cure rates for whipworm; always use 3-day regimen 3, 4
• Inadequate monitoring: Failure to check blood counts and liver enzymes during prolonged therapy can miss serious toxicity 7, 2
• Wrong drug selection: For Hymenolepis nana, praziquantel is preferred over albendazole 6
• Forgetting food: Absorption significantly improves with fatty meals—this is not optional 7, 2