Pinworm Treatment
For typical enterobiasis (pinworm infection), treat with a single oral dose of either albendazole 400 mg or mebendazole 100 mg, repeated in 2 weeks, with both medications showing equivalent efficacy and safety across all age groups. 1, 2
First-Line Treatment Options
Both medications are equally effective and represent standard therapy:
- Albendazole 400 mg as a single oral dose, repeated in 2 weeks 1
- Mebendazole 100 mg as a single oral dose, repeated in 2 weeks 1, 2
The FDA-approved mebendazole formulation achieves a 95% cure rate for pinworm infection 2. The tablet may be chewed, swallowed, or crushed and mixed with food 2. Both albendazole and mebendazole are adulticidal and ovicidal, providing comprehensive treatment 3.
Dosing Across Age Groups
- The same dose applies to all ages, including young children (≥2 years) and adults—there is no weight-based adjustment needed for pinworm treatment 1, 2
- For children aged 12-24 months, expert consultation is recommended before treatment 4
Repeat Dosing Strategy
- The second dose at 2 weeks is critical to eradicate newly hatched worms from eggs that survived the initial treatment 1
- If the patient remains symptomatic 3 weeks after the second dose, administer a third treatment course 2
- No special procedures such as fasting or purging are required 2
Household and Contact Management
Treat all household members simultaneously, especially when multiple or repeated symptomatic infections occur, as reinfection is extremely common even with effective medication 3, 5. This includes sexual partners in adult cases 5.
Clinical Presentation to Recognize
- Nocturnal perianal itching is the hallmark symptom, though 30-40% of infected patients are asymptomatic 1, 3
- Additional symptoms include irritability, weight loss, diarrhea, abdominal pain, and vaginal discharge in girls due to genital tract colonization 1
Diagnostic Confirmation
- Cellophane tape test (sticky side applied to perianal skin in the morning before bathing) is the preferred diagnostic method 1
- A single test has only 50% sensitivity, but three tests performed on different mornings increase sensitivity to approximately 90% 3
- Stool examination is not recommended as pinworms and eggs are not usually passed in stool 1, 3
Treatment Failure vs. Reinfection
Persistent symptoms after appropriate treatment almost always indicate reinfection rather than medication resistance, given the short life span of adult pinworms and ease of autoinfection 1. True treatment failure is rare 1.
Preventive Measures
Essential hygiene practices to prevent reinfection include:
- Frequent handwashing, especially after bowel movements and before meals 3
- Clipping fingernails short 3
- Avoiding finger-sucking, nail-biting, and scratching the anogenital area 3
- Daily morning bathing to remove eggs deposited overnight 5
Special Population Considerations
- For pregnant women, pyrantel pamoate is preferred over albendazole or mebendazole due to safety profile 3
- Extended treatment with a "pulse scheme" for up to 16 weeks may be necessary for recurrent infections 5
Monitoring for Extended Treatment
If treatment extends beyond 14 days (as in recurrent cases requiring pulse therapy), monitor for hepatotoxicity and leukopenia 1, 4.