What is the recommended albendazole dosage for adults and children for intestinal helminth infections, giardiasis, neurocysticercosis, and hepatic cystic echinococcosis, including adjustments for hepatic impairment and pediatric weight categories?

Albendazole Dosing Recommendations

For intestinal helminth infections in adults and children over 24 months, use albendazole 400 mg as a single oral dose, with repeat dosing at 2 weeks for pinworm and hookworm infections; for neurocysticercosis, use 15 mg/kg/day divided twice daily (maximum 1200 mg/day) for 10-14 days with food. 1

Intestinal Helminth Infections

Standard Single-Dose Regimens (Adults and Children >24 months)

• Ascariasis (roundworm): Albendazole 400 mg as a single oral dose 2, 1, 3
• Pinworm (Enterobius vermicularis): Albendazole 400 mg as a single dose, repeated in 2 weeks 1
• Hookworm (light infections): Albendazole 400 mg as a single dose 1

Multi-Day Regimens for Specific Infections

• Hookworm (moderate to heavy infections): Albendazole 400 mg daily for 3 days 1, 4
• Whipworm (Trichuris trichiura): Albendazole 400 mg daily for 3 days 1
  • Note: Single-dose albendazole has limited efficacy against Trichuris, with cure rates of only 27-48% and egg reduction of 39-85% 5, 6

Pediatric Considerations

• Children >24 months: Use standard adult dosing of 400 mg for single-dose regimens 1
• Children 12-24 months: Expert consultation required before treatment 1
• Children <12 months: Not addressed in current guidelines; specialist consultation mandatory

Neurocysticercosis

Viable Parenchymal Cysticerci

• 1-2 cysts: Albendazole 15 mg/kg/day divided into 2 daily doses for 10-14 days (maximum 1200 mg/day) 2
• >2 cysts: Albendazole 15 mg/kg/day combined with praziquantel 50 mg/kg/day for 10-14 days 2

Subarachnoid/Extraparenchymal Lesions

• Albendazole 15 mg/kg/day in twice-daily doses for 1-2 weeks 2
• Corticosteroids must be initiated prior to antiparasitic therapy 2

Special Parasitic Infections

• Gnathostomiasis: Albendazole 400 mg twice daily for 21 days 1
• Microsporidia (Encephalitozoon intestinalis): Albendazole 7.5 mg/kg orally twice daily (maximum 400 mg twice daily) in patients weighing <60 kg 2
• Toxocariasis: Requires specialist consultation for dosing, often combined with corticosteroids 1

Critical Administration Requirements

Albendazole must always be administered with food, preferably fatty meals, to maximize absorption. 1 This is essential as bioavailability is significantly enhanced by fat intake.

• Avoid liquid paraffin (mineral oil) during treatment as it significantly impairs albendazole absorption 1

Monitoring Requirements

For Treatment >14 Days

Monitor complete blood counts and liver enzymes (transaminases) at the beginning of each 28-day cycle and every 2 weeks during therapy. 2, 1

• Leukopenia occurs in up to 10% of patients 1
• Elevated liver enzymes occur in up to 16% with prolonged treatment 1

For Combination Therapy

• No additional monitoring needed for albendazole plus praziquantel beyond that recommended for albendazole monotherapy 2

Critical Drug Interactions

• Dexamethasone increases albendazole levels by approximately 56%, which may be therapeutically beneficial in neurocysticercosis 1
• Praziquantel significantly increases albendazole exposure but co-administration is safe and commonly recommended without additional monitoring 1

Essential Pre-Treatment Screening

Before Initiating Albendazole

• Fundoscopic examination mandatory to detect retinal cysticercosis before anthelmintic therapy 2, 1
• Screen for Strongyloides stercoralis in patients requiring prolonged corticosteroids, as hyperinfection syndrome can be fatal 2, 1
• Screen for latent tuberculosis in patients likely to require prolonged corticosteroids 2
• Exclude Loa loa infection before administering ivermectin in patients from Central/West African endemic regions 1

Common Pitfalls to Avoid

• Do not treat neurocysticercosis patients with untreated hydrocephalus or diffuse cerebral edema with antiparasitic drugs; manage elevated intracranial pressure first 2
• Do not use single-dose albendazole for Trichuris infections; efficacy is poor and 3-day regimens are required 1, 6
• Do not forget to repeat dosing at 2 weeks for pinworm and hookworm infections to prevent reinfection 1
• Do not administer without food, as absorption is critically dependent on fat intake 1