What is the treatment for gastric worms?

Treatment of Gastric Worms

For gastric worms (helminthic infections of the stomach), albendazole 400 mg orally as a single dose is the recommended first-line treatment, with a repeat dose in 2 weeks. 1, 2

Specific Treatment Regimens by Parasite Type

The term "gastric worms" can refer to several different parasitic infections that may involve the stomach or gastrointestinal tract. Treatment varies based on the specific parasite:

Hookworm (Most Common Gastric/Intestinal Helminth)

• Albendazole 400 mg orally as a single dose, repeated in 2 weeks is the standard treatment for both Ancylostoma duodenale and Necator americanus 1, 2
• Alternative regimen: Albendazole 400 mg daily for 3 days for more severe infections 3
• Mebendazole 100 mg twice daily for 3 days is an alternative option with cure rates of approximately 82% for hookworm 4, 5

Roundworm (Ascaris lumbricoides)

• Albendazole 400 mg as a single dose achieves 100% cure rates 6
• Mebendazole 100 mg twice daily for 3 days is equally effective with 100% cure rates 5

Whipworm (Trichuris trichiura)

• Mebendazole 100 mg twice daily PLUS ivermectin 200 μg/kg once daily for 3 days is recommended due to lower efficacy of single-agent therapy 3
• Albendazole alone has lower cure rates (27-60%) for whipworm compared to other helminths 6

Pinworm (Enterobius vermicularis)

• Albendazole 400 mg or mebendazole 100 mg as a single dose, repeated in 2 weeks 1, 7
• Treat all household contacts simultaneously due to high contagiousness 3, 7

Strongyloides (Threadworm)

• Ivermectin 200 μg/kg as a single dose is preferred for normal immunity 1
• For immunocompromised patients: Ivermectin 200 μg/kg on days 1,2,15, and 16 1
• Alternative: Albendazole 400 mg twice daily for 21 days with monitoring of liver function and complete blood count 3

Empiric Treatment for Undiagnosed Cases

When stool studies are negative but clinical suspicion remains high (e.g., eosinophilia, travel to endemic areas, gastrointestinal symptoms):

• Albendazole 400 mg PLUS ivermectin 200 μg/kg as a single combined dose provides broad-spectrum coverage 2, 3
• This combination is safe, single-dose, and highly effective against most soil-transmitted helminths 2
• Particularly useful for travelers returning from endemic areas with prolonged exposure 2

Critical Safety Considerations

Pre-Treatment Screening

• Screen for Loa loa infection before administering ivermectin in patients from Central/West Africa to prevent severe encephalopathy 3
• Exclude co-existing onchocerciasis or loiasis before treatment in patients from endemic regions 1

Monitoring Requirements

• For treatment extending beyond 14 days, monitor for hepatotoxicity and leukopenia 2
• Liver function tests and complete blood count monitoring recommended for prolonged albendazole therapy (>21 days) 3

Special Populations

• For children aged 12-24 months, seek expert consultation before treatment 2, 3
• For pregnant women, pyrantel pamoate is preferred over albendazole and mebendazole 7

Follow-Up and Monitoring

• Perform at least three stool examinations over 3 months following treatment to ensure eradication, as recrudescence can occur up to 106 days post-treatment 8
• Use concentration techniques (such as Baermann apparatus) for stool examination, as parasite burden may be very low 8
• If symptoms persist, repeat stool examination 2-3 weeks after treatment 2
• Consider retreatment 1 month after symptom resolution to ensure adult worms are eliminated 2

Prevention of Reinfection

• Hand hygiene with soap before eating and after defecation 3
• Wearing shoes in endemic areas to prevent larval skin penetration 2, 3
• Treating household contacts for highly contagious infections like pinworm 3, 7
• Avoiding consumption of unwashed produce in endemic areas 2

Common Pitfalls to Avoid

• Do not rely on single stool examination: Multiple samples increase diagnostic yield due to intermittent egg shedding 2
• Do not use ivermectin without screening for Loa loa in at-risk populations: This can cause fatal encephalopathy 3
• Do not assume treatment failure without proper follow-up: Recurrence may represent reinfection rather than treatment failure 2, 7
• Be aware of emerging drug resistance in hookworm, Trichuris trichiura, and possibly Ascaris lumbricoides 9