Albendazole Regimen for Parasitic Infections
For most common intestinal parasitic infections, albendazole 400 mg as a single oral dose is the standard treatment, though specific parasites require different durations ranging from single-dose to 21-day courses. 1, 2
Standard Single-Dose Regimens (400 mg)
The following infections are effectively treated with albendazole 400 mg as a single oral dose: 1, 2
- Ascariasis (roundworm) - 400 mg once 1
- Enterobiasis (pinworm) - 400 mg once 1
- Hookworm (initial treatment) - 400 mg once, though 3-day course preferred for complete eradication 1, 2
Multi-Day Treatment Regimens
Three-Day Courses
Hookworm infections require albendazole 400 mg daily for 3 days for optimal cure rates. 1, 2 This extended regimen significantly improves eradication compared to single-dose treatment. 1
Extended Courses (7+ Days)
Strongyloidiasis: Albendazole 400 mg twice daily for 3-7 days can be used as an alternative when ivermectin is unavailable, though ivermectin 200 μg/kg single dose is strongly preferred. 2 Note that albendazole cure rates for strongyloidiasis are lower than ivermectin. 3
Loiasis: Albendazole 400 mg daily for 10-28 days for high microfilarial loads, with doses up to 800 mg daily for treatment failure. 2 Always exclude Loa loa infection before administering ivermectin, as co-administration can cause severe adverse reactions. 2, 4
Microsporidiosis: Albendazole 7.5 mg/kg (maximum 400 mg/dose) twice daily until immune reconstitution. 2
Tissue Infections and Severe Disease
Neurocysticercosis
For patients ≥60 kg: albendazole 400 mg twice daily for 8-30 days. 5 For patients <60 kg: 15 mg/kg/day in divided doses twice daily (maximum 800 mg/day). 5 Concomitant oral or intravenous corticosteroids and anticonvulsants are mandatory to prevent cerebral hypertensive episodes during the first week of treatment. 5, 2
Hydatid Disease (Echinococcosis)
For patients ≥60 kg: albendazole 400 mg twice daily for 28-day cycles, followed by 14-day drug-free intervals, for a total of 3 cycles. 5, 1 For patients <60 kg: 15 mg/kg/day in divided doses (maximum 800 mg/day). 5 Smaller cysts (<5 cm) may be treated with albendazole alone, while larger cysts require combination with praziquantel and/or surgical intervention. 1
Trichinellosis
Albendazole 400 mg once daily for 3 days in mild disease; severe disease requires specialist management with extended courses. 1
Empirical Treatment for Asymptomatic Eosinophilia
For returning travelers or migrants with unexplained eosinophilia: albendazole 400 mg plus ivermectin 200 μg/kg as a single combined dose. 2, 4 This covers most helminthic causes of eosinophilia. 2
Administration Guidelines
- Always administer albendazole with food to enhance absorption. 5
- Tablets may be crushed or chewed and swallowed with water. 5
- For children >24 months: same 400 mg dose as adults. 2, 4
- For children 12-24 months: specialist consultation required before treatment. 2, 4
Critical Monitoring Requirements
Before and during treatment, monitor: 5
- Blood counts: At the beginning of each 28-day cycle and every 2 weeks during therapy. 5 Discontinue if clinically significant decreases occur. 5
- Liver enzymes (transaminases): At the beginning of each cycle and at least every 2 weeks during treatment. 5
- Pregnancy test: Required in all females of reproductive potential before initiating therapy. 5
Patients with liver disease or hepatic echinococcosis require more frequent monitoring due to increased risk of bone marrow suppression. 5
Important Safety Considerations
Albendazole is contraindicated in pregnancy due to embryo-fetal toxicity. 5 Advise females of reproductive potential to use effective contraception during treatment and for 3 days after the final dose. 5
Common pitfall: For T. solium (pork tapeworm) intestinal infection, use niclosamide 2 g single dose instead of praziquantel unless neurocysticercosis has been definitively excluded. 1, 2 Praziquantel can precipitate neurological symptoms if cysticercosis is present. 1
Fatalities have been reported due to granulocytopenia or pancytopenia with albendazole use. 5 This risk increases with prolonged treatment courses (>14-28 days). 6
Infections Where Albendazole Has Limited Efficacy
Whipworm (Trichuris trichiura): Mebendazole 100 mg twice daily combined with ivermectin is preferred due to low albendazole cure rates. 1, 7, 8 Single-dose albendazole achieves only 27-48% cure rates for Trichuris. 8
Schistosomiasis: Praziquantel is the drug of choice; albendazole is not effective. 1