What is the recommended deworming treatment for a 13-year-old patient?

Deworming for a 13-Year-Old

For a 13-year-old requiring deworming, administer albendazole 400 mg as a single oral dose with food, which effectively treats the most common intestinal worm infections including roundworm, hookworm, and whipworm. 1, 2

Standard Treatment Approach

Albendazole 400 mg single dose is the first-line treatment for soil-transmitted helminths (geohelminths) in adolescents, covering the most prevalent infections: 1

• Roundworm (Ascaris lumbricoides): Albendazole 400 mg single dose 1
• Hookworm (Ancylostoma/Necator): Albendazole 400 mg single dose 1
• Whipworm (Trichuris trichiura): Albendazole 400 mg single dose 1
• Pinworm (Enterobius vermicularis): Albendazole 400 mg single dose 1

Alternative Option

Mebendazole 500 mg as a single dose can be used as an alternative if albendazole is unavailable or contraindicated. 1

Critical Administration Instructions

Administer albendazole with food to enhance absorption—oral bioavailability increases up to 5-fold when given with a fatty meal (approximately 40 grams of fat). 2

For a 13-year-old, give the tablet whole with water. The crushing recommendation only applies to children under 3 years old to reduce choking risk. 2, 3

Empirical Treatment Strategy

If diagnostic testing is unavailable or negative but clinical suspicion remains high, consider empirical treatment with: 1

• Albendazole 400 mg single dose PLUS
• Ivermectin 200 μg/kg (microgram per kilogram) single dose 1

This combination covers potential prepatent infections (worms not yet producing eggs) and Strongyloides, which has lower sensitivity on stool microscopy. 1

Critical Precaution Before Ivermectin

Before administering ivermectin, exclude Loa loa infection if the patient has traveled to endemic regions (Central/West Africa), as ivermectin can cause severe adverse reactions in Loa loa-infected individuals. 1

Special Considerations for Specific Worm Infections

Tapeworm Infections

If tapeworm (Taenia species) is suspected or confirmed: 1

• Praziquantel 10 mg/kg as a single dose 1
• Establish species identification if possible, as T. solium may coexist with neurocysticercosis requiring different management 1

Dwarf Tapeworm

For Hymenolepis nana: 1

• Praziquantel 25 mg/kg as a single dose (higher dose than for Taenia) 1

Schistosomiasis

If acute schistosomiasis (Katayama syndrome) is suspected based on fever, eosinophilia, and freshwater exposure 2-8 weeks prior: 1

• Praziquantel 25 mg/kg three times daily for 2-3 consecutive days 1
• Repeat treatment at 8 weeks to treat any residual worms that mature after initial treatment 1

Follow-Up Treatment

For confirmed schistosomiasis or persistent symptoms, repeat albendazole treatment at 8 weeks after initial dosing, as eggs and immature worms are relatively resistant to single-dose treatment. 1

Common Pitfalls to Avoid

Do not give albendazole on an empty stomach—this significantly reduces drug absorption and treatment efficacy. 2

Do not crush tablets for a 13-year-old—crushing increases risk of adverse swallowing events (25.4% vs 3.6% with whole tablets) and choking, particularly when mixed with water (34.6% adverse event rate). 3

Do not assume negative stool microscopy rules out infection—Strongyloides has low sensitivity on standard stool examination, and prepatent infections (before egg production begins) will not be detected. 1

Do not administer ivermectin without excluding Loa loa in patients with travel history to endemic areas, as this can cause fatal encephalopathy. 1

For females of reproductive potential, ensure effective contraception during treatment and for 3 days after the final dose, as albendazole poses fetal risk. 2

Monitoring Requirements

No routine laboratory monitoring is required for single-dose albendazole treatment in otherwise healthy adolescents. 2

For prolonged or repeated courses (not typical for routine deworming), monitor blood counts and liver enzymes every 2 weeks due to potential bone marrow and hepatic toxicity. 2

Expected Outcomes

Pharmacokinetics in adolescents aged 6-13 years are similar to adults, with peak plasma concentrations of the active metabolite (albendazole sulfoxide) occurring 2-5 hours after dosing and elimination half-life of 8-12 hours. 2

Clinical improvement should be evident within days to weeks, though complete resolution of symptoms may take longer depending on the worm burden and species involved. 1