Treatment for Hymenolepis Nana Infection

The recommended treatment for Hymenolepis nana is praziquantel 25 mg/kg orally as a single dose, which achieves cure rates exceeding 95%. 1

First-Line Treatment Regimen

Praziquantel 25 mg/kg as a single oral dose is the treatment of choice for H. nana infection, based on current UK guidelines for parasitic infections in travelers and migrants 1
This dosing achieves a 98.5% cure rate in pediatric populations, as demonstrated in clinical trials of 155 infected children 2
The single-dose regimen is effective because praziquantel acts against both the adult worms and the larval cysticercoid stages in the intestinal mucosa 2

Niclosamide 2 g orally once daily for 7 days is an acceptable alternative when praziquantel is unavailable or contraindicated 1
This extended course is necessary with niclosamide because it only kills adult worms and does not affect the tissue-dwelling larval stages, requiring prolonged treatment to catch newly matured worms 1

H. nana is the most common tapeworm infection worldwide, particularly affecting children and institutionalized individuals in developed countries 1
Most infections are asymptomatic, but heavy worm burdens can cause diarrhea and abdominal pain 1
The parasite has a unique ability to cause autoinfection, where eggs can hatch within the intestine and reinfect the same host without leaving the body 1

Diagnosis is made through concentrated stool microscopy or fecal PCR to identify characteristic eggs 1
Multiple stool samples may increase diagnostic yield due to intermittent egg shedding 3

Praziquantel at 25 mg/kg is well-tolerated with minimal side effects 2
In clinical trials, no significant clinical adverse effects were observed, and laboratory parameters (blood and urine tests) remained within normal limits 2
Some patients may experience mild abdominal pain or diarrhea, which are self-limited 4, 5

The 25 mg/kg dose is superior to lower doses: cure rates of 98.5% at 25 mg/kg versus 93.8% at 15 mg/kg and only 76% at 10 mg/kg 2
Some studies have used 20 mg/kg with complete efficacy, but the guideline-recommended 25 mg/kg provides the highest margin of success 1, 4, 5

Do not use the lower 10 mg/kg dose recommended for Taenia species when treating H. nana, as this significantly reduces cure rates from 98.5% to 76% 1, 2
The higher dose requirement for H. nana reflects the need to kill both adult worms and larval cysticercoids in the intestinal wall 2

Post-treatment stool examination can confirm cure, though this is not always necessary in asymptomatic patients who received appropriate treatment 1
Reinfection is possible through fecal-oral transmission, so hygiene education is important, particularly in institutional settings 1