What is the treatment for finding worms in feces?

Treatment of Worms in Feces

For most intestinal worm infections, treat with albendazole 400 mg orally as a single dose, which is effective for roundworm, hookworm, and pinworm. 1, 2

Diagnostic Approach First

Before treating, identify the specific worm type when possible:

• Visible worms in stool suggest roundworm (pink/white, earthworm-sized) or tapeworm (segments visible) 1, 3
• Concentrated stool microscopy is first-line for most helminths, with fecal PCR offering higher sensitivity when available 1, 2
• Travel history and exposure guide empirical treatment decisions 1, 2

Treatment by Specific Worm Type

Roundworm (Ascaris lumbricoides)

• Albendazole 400 mg PO single dose OR mebendazole 500 mg PO single dose OR ivermectin 200 μg/kg PO single dose 1
• All three options are equally effective 1

Hookworm (Ancylostoma/Necator)

• Albendazole 400 mg PO daily for 3 days (not single dose for hookworm) 2
• For severe disease with anemia, add prednisolone 40-60 mg once daily 2

Whipworm (Trichuris trichiura)

• Mebendazole 100 mg PO twice daily PLUS ivermectin 200 μg/kg once daily for 3 days 2
• This combination is necessary because whipworm has lower cure rates with single-agent therapy 4

Pinworm (Enterobius vermicularis)

• Albendazole 400 mg PO single dose OR mebendazole 100 mg PO single dose 2, 5
• Treat all household contacts simultaneously due to high contagiousness 2, 5
• For recurrent infections, use prolonged "pulse scheme" treatment for up to 16 weeks 5

Tapeworm (Taenia species)

Critical distinction for T. solium:

• Use niclosamide 2 g PO single dose for T. solium (pork tapeworm) 1
• Never use praziquantel for T. solium unless neurocysticercosis has been excluded, as antiparasitic agents can worsen cerebral edema 1
• For T. saginata (beef tapeworm): praziquantel 10 mg/kg PO single dose 1
• If species uncertain, use niclosamide 2 g PO single dose to avoid risk 1

Dwarf Tapeworm (Hymenolepis nana)

• Praziquantel 25 mg/kg PO single dose 1, 3

Schistosomiasis (if blood flukes suspected)

• Praziquantel 40 mg/kg PO single dose for S. mansoni 1
• Praziquantel 60 mg/kg PO in two divided doses for S. japonicum/mekongi or unknown Asian-Pacific species 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
• This provides broad coverage for most intestinal helminths 2

Critical Safety Precautions

Before Using Ivermectin:

• Screen for Loa loa infection in patients from Central/West Africa before giving ivermectin to prevent severe encephalopathy 2
• Exclude Loa loa before ivermectin in any patient from endemic regions 1, 2

Albendazole Monitoring:

• Monitor for hepatotoxicity and leukopenia if treating for >14 days 1
• Elevated liver enzymes occur in up to 16% with prolonged therapy, requiring discontinuation in 3.8% 1
• Take albendazole with fatty meals to improve absorption 1

Special Populations:

• Do not use mebendazole in pregnancy 6
• Seek specialist advice for immunocompromised patients, children aged 12-24 months, and severe disease 2

Prevention of Reinfection

Essential hygiene measures to prevent reinfection:

• Wash hands and fingernails with soap frequently, especially before eating and after toilet use 1, 2, 6
• Wear shoes in endemic areas to prevent hookworm penetration through skin 1, 2
• Treat household contacts simultaneously for pinworm due to high contagiousness 2, 5
• For pinworm: wear tight underwear day and night, change daily, vacuum bedroom floors, wash bed linens after treatment 6
• Wash all fruits and vegetables thoroughly or cook them well 6

Common Pitfalls to Avoid

• Do not assume all "worms in stool" are the same - tapeworm requires different treatment than roundworm 1
• Do not use praziquantel empirically without excluding T. solium - risk of neurocysticercosis complications 1
• Do not give single-dose albendazole for hookworm - requires 3-day course unlike other helminths 2
• Do not forget to treat household contacts for pinworm - reinfection is nearly universal without this step 2, 5
• Stool microscopy for tapeworm carriers has low sensitivity; even multiple examinations may be negative 1

Follow-Up

• Repeat stool examination 2-3 weeks after treatment if symptoms persist 3
• Consider alternative diagnoses or resistant infection if no improvement after appropriate treatment 3
• For tapeworm carriers who are food handlers, notify public health authorities as this poses public health risk 1