What is the recommended treatment for ascariasis in children?

Treatment of Ascariasis in Children

For children with ascariasis, administer a single oral dose of either albendazole 400 mg, mebendazole 500 mg, or ivermectin 200 μg/kg—all three options achieve cure rates exceeding 90% and are equally effective. 1, 2

First-Line Treatment Options

All three medications below are considered equivalent first-line choices:

• Albendazole 400 mg as a single oral dose 1, 2, 3

  • Cure rate: approximately 93-98% 4, 5
  • Can be used in children as young as 12 months 6
  • May be chewed, swallowed, or crushed and mixed with food 3

• Mebendazole 500 mg as a single oral dose 1, 7, 2

  • Cure rate: approximately 97% 4
  • Equally effective as albendazole for ascariasis 4, 5
  • FDA-approved indication with 98% cure rate 3

• Ivermectin 200 μg/kg as a single oral dose 1, 2

  • Cure rate: approximately 90% 4
  • No significant difference in efficacy compared to albendazole 4

Alternative Dosing Regimen

If single-dose therapy is unavailable or preferred otherwise:

• Mebendazole 100 mg twice daily for 3 consecutive days 3
  • This is the FDA-labeled alternative regimen for ascariasis 3
  • No fasting or purging required 3

Age-Specific Considerations

• Children ≥12 months: All three medications (albendazole, mebendazole, ivermectin) are safe and effective 6
• Children <12 months: Limited data exists, but benzimidazoles may be used if local circumstances justify treatment for symptomatic infection 6

Expected Treatment Outcomes

• Parasitological cure: 93-98% across all three medications 4
• Egg reduction rate: 96-100% within 14-60 days post-treatment 4
• Failure rates: Range from 0-30% depending on infection intensity and drug used 4

Safety Profile

All three medications demonstrate excellent safety in children:

• Common mild adverse events (similar across all drugs): nausea, vomiting, abdominal pain, diarrhea, headache, fever 4
• Serious adverse events: None reported in clinical trials 4
• Drug tolerance: Well-tolerated in children as young as 12 months 6, 5

Special Clinical Scenarios

Loeffler's Syndrome (Larval Migration Phase)

• Treat with albendazole 400 mg or mebendazole 500 mg single dose 7
• Consider repeating treatment one month after resolution of pulmonary symptoms 7
• Critical caveat: Screen for or empirically treat Strongyloides stercoralis before initiating corticosteroids to prevent hyperinfection syndrome 2

Complicated Ascariasis

• Intestinal obstruction (more common in children with heavy worm burden): May require surgical intervention in addition to anthelmintic therapy 1, 2
• Biliary obstruction (more common in adults): May require endoscopic or surgical management alongside medical treatment 1, 2

Follow-Up and Retreatment

• Routine follow-up: Not typically needed unless symptoms persist 1
• If treatment fails: Repeat the same regimen 3 weeks after initial treatment 3
• Stool examination: Can confirm cure using concentrated stool microscopy or fecal PCR if available 1

Infection Control in Congregate Settings

When treating children in schools, psychiatric units, or other group settings:

• Implement standard enteric precautions immediately 2
• Ensure proper hand hygiene after toileting and before meals 2
• Monitor bathroom facilities for cleanliness 2
• Consider temporary isolation or cohorting if multiple cases occur 2

Common Pitfalls to Avoid

• Don't delay treatment: Single-dose therapy is highly effective and well-tolerated; waiting for "optimal timing" is unnecessary 2
• Don't overlook infection control: In congregate settings, failure to implement enteric precautions risks transmission to other children and staff 2
• Don't assume treatment failure early: Worms may be passed or regurgitated for several days post-treatment as they are expelled—this is expected, not treatment failure 2