What is the appropriate dosage and administration protocol for Albendazole in an 8-year-old patient with a parasitic infection?

Albendazole Dosing for an 8-Year-Old Child

For an 8-year-old child with a parasitic infection, administer albendazole 400 mg as a single oral dose with food for common intestinal helminths (roundworm, hookworm, pinworm), or 400 mg twice daily for 8-30 days for neurocysticercosis, depending on the specific parasitic infection. 1

Weight-Based Dosing Algorithm

The FDA-approved dosing is straightforward and weight-dependent 1:

• If the child weighs ≥60 kg: 400 mg twice daily with meals
• If the child weighs <60 kg (most 8-year-olds): 15 mg/kg/day divided into two doses with meals (maximum 800 mg/day total)

Infection-Specific Treatment Duration

Single-Dose Regimens (Most Common)

• Ascariasis (roundworm): 400 mg single dose 2, 3
• Hookworm: 400 mg single dose (may extend to 3 days for complete eradication) 2
• Enterobiasis (pinworm): 400 mg single dose 2, 3

Multi-Day Regimens

• Neurocysticercosis: 15 mg/kg/day divided twice daily for 8-30 days (maximum 1200 mg/day for parenchymal disease) 4, 1
• Strongyloidiasis: 400 mg twice daily for 3-7 days (though ivermectin is preferred) 2
• Taenia species: 400 mg daily for 3 days 3

Critical Administration Guidelines

Always administer albendazole with food to enhance absorption 1. The tablet may be crushed or chewed and swallowed with water, which is particularly helpful for pediatric patients 1.

Essential Safety Monitoring

For treatment courses longer than 14 days, the IDSA/ASTMH guidelines mandate monitoring 4:

• Hepatotoxicity monitoring: Check liver enzymes at baseline and every 2 weeks during therapy 4, 1
• Leukopenia monitoring: Check complete blood counts at baseline and every 2 weeks 4, 1

Special Considerations for Neurocysticercosis

If treating neurocysticercosis, concomitant therapy is mandatory 4, 1:

• Corticosteroids: Initiate BEFORE starting albendazole to prevent cerebral hypertensive episodes 4, 1
• Anticonvulsants: For all patients with seizures 4
• Fundoscopic examination: Required prior to treatment initiation to exclude retinal involvement 4

Critical Safety Precautions

Screen for Strongyloides stercoralis before prolonged corticosteroid use if treating neurocysticercosis, as steroids can precipitate fatal hyperinfection syndrome 4.

Always exclude Loa loa infection in children who have traveled to endemic regions before co-administering ivermectin 2, 5.

Common Pitfalls to Avoid

• Do not underdose: The maximum daily dose is 800 mg for most infections, but can be up to 1200 mg/day for neurocysticercosis 4
• Do not skip food: Albendazole absorption is significantly enhanced when taken with meals 1
• Do not forget corticosteroids: For neurocysticercosis, starting albendazole without steroids can cause life-threatening cerebral edema 4, 1
• Do not use single-dose for all infections: While convenient, Trichuris and certain other parasites require multi-day regimens for adequate cure rates 2, 6