What is the recommended treatment for intestinal Taenia coli infection?

Treatment for Taenia Coli (Intestinal Tapeworm Infection)

Treat intestinal Taenia infections with praziquantel 10 mg/kg as a single oral dose, which achieves cure rates approaching 100% and is well-tolerated. 1

Critical First Step: Species Identification

Before initiating treatment, you must determine whether the infection is Taenia saginata (beef tapeworm) or Taenia solium (pork tapeworm), as this fundamentally changes your management approach. 1

• Obtain concentrated stool microscopy for ova or worm segments (proglottids) to establish species identification 1
• Examine passed segments microscopically if the patient has visualized worm segments in stool 2
• Note that eggs are eliminated intermittently, so multiple specimens may be required for diagnosis 1

Treatment Algorithm Based on Species

For Taenia saginata (Beef Tapeworm)

Administer praziquantel 10 mg/kg as a single oral dose with food. 1, 2, 3

• This regimen achieves 96-100% cure rates in clinical trials 4, 5, 6
• The drug is well-tolerated with minimal side effects 4, 5
• Alternative option: niclosamide 2g as a single oral dose 2

For Taenia solium (Pork Tapeworm)

Use niclosamide 2g as a single oral dose—NOT praziquantel—unless you have definitively excluded neurocysticercosis. 2

• Praziquantel is contraindicated in T. solium until neurocysticercosis is ruled out, as it can precipitate severe neurological deterioration if brain cysts are present 2, 7
• Niclosamide only kills adult intestinal worms and does not affect tissue cysts, making it safer when cysticercosis status is unknown 2
• If concomitant neurocysticercosis is confirmed, treatment requires steroids plus albendazole 15 mg/kg/day (maximum 1200 mg/day) for 8-30 days, NOT praziquantel alone 1, 2, 7

For Unknown Taenia Species

Default to niclosamide 2g as a single oral dose when species cannot be identified, as this avoids potential catastrophic complications if undiagnosed T. solium with neurocysticercosis is present. 2

Mandatory Screening for T. solium Infections

When T. solium is identified or suspected:

• Obtain cysticercosis serology to screen for tissue involvement 1, 2
• Consider neuroimaging (CT or MRI brain with contrast) in patients from endemic areas (Central/South America, South Asia) or those with any neurological symptoms 1, 2
• Perform fundoscopic examination to exclude ocular cysticercosis before treatment 1, 2
• Screen household contacts with stool microscopy, as they may be asymptomatic tapeworm carriers who transmitted the infection 1, 2

Administration and Monitoring

• Take praziquantel with food to enhance absorption 3, 7
• Avoid concurrent dexamethasone, which reduces praziquantel levels through hepatic metabolism; use prednisolone if corticosteroids are necessary 3
• No routine laboratory monitoring is required for single-dose praziquantel therapy 1
• Expected side effects are mild and transient: abdominal pain (50% of patients), soft stool/diarrhea, and dizziness 5, 6

Common Pitfalls to Avoid

• Never use praziquantel empirically for suspected T. solium without excluding neurocysticercosis first—this can cause fatal cerebral edema 1, 2, 7
• Do not assume a single negative stool exam rules out tapeworm infection, as egg shedding is intermittent 1
• Remember that T. solium carriers pose a public health risk, especially food handlers, and must be reported to local health authorities 1, 2
• Recognize the prolonged incubation period for neurocysticercosis (average 3.5 years, up to >10 years), so patients may develop symptoms long after leaving endemic areas 1

Public Health Considerations

• Notify local public health authorities of all T. solium cases, as tapeworm carriage is reportable in many jurisdictions 1, 2
• Screen household contacts and food handlers for tapeworm carriage to prevent ongoing transmission 1, 2