What is the recommended albendazole dose for hookworm infection in a healthy individual older than two years, and what alternative regimens should be used for pregnant women, patients with severe malnutrition, chronic liver disease, or benzimidazole hypersensitivity?

Albendazole for Hookworm Infection

Standard Treatment Regimen

For hookworm infection in healthy individuals older than two years, albendazole 400 mg orally daily for 3 consecutive days is the recommended treatment. 1

• Single-dose albendazole (400 mg once) achieves only modest cure rates of 36–69% against hookworm, with egg reduction rates of 87–97%, making it insufficient for reliable eradication. 2, 3
• The 3-day regimen (400 mg daily × 3 days) increases cure rates to 92–97% and egg reduction rates to 99.7–99.8%, providing superior efficacy. 1, 3
• Albendazole must be taken with food, preferably a fatty meal, to maximize absorption and therapeutic efficacy. 4

Pediatric Dosing (Ages 2–24 Months)

• Children older than 24 months receive the same adult dose: 400 mg daily for 3 days. 4
• For children aged 12–24 months, expert consultation is required before treatment, as safety data in this age group are limited. 4, 5
• Children under 12 months should not receive albendazole without specialist guidance. 4

Special Populations Requiring Alternative Management

Pregnant Women

• Albendazole is contraindicated in the first trimester of pregnancy due to teratogenic risk. 4
• In the second and third trimesters, use albendazole only when the therapeutic benefit clearly outweighs potential fetal risk; delay treatment until after delivery whenever clinically feasible. 4
• If treatment cannot be deferred and hookworm is causing severe anemia, consider iron supplementation as primary management with deferred antiparasitic therapy. 1

Patients with Severe Malnutrition

• Malnourished children with hookworm are at higher risk for severe anemia; prioritize nutritional rehabilitation and iron supplementation alongside antiparasitic treatment. 1
• Standard albendazole dosing (400 mg daily × 3 days) can be used, but monitor closely for adverse effects, as malnutrition may increase susceptibility to drug toxicity. 4

Chronic Liver Disease

• Albendazole is contraindicated in patients with active hepatic disease due to risk of hepatotoxicity, which occurs in up to 16% of patients on prolonged therapy. 4, 5
• If treatment is essential, use the shortest effective course (3 days) and monitor liver transaminases at baseline and every 2 weeks during therapy. 4
• Consider mebendazole as an alternative, though it also carries hepatotoxicity risk and has lower efficacy against hookworm (cure rate 29–54%). 2, 3

Benzimidazole Hypersensitivity

• Patients with known hypersensitivity to benzimidazole compounds (albendazole, mebendazole) should receive ivermectin 200 μg/kg as a single dose, repeated after 2 weeks. 1, 4
• Ivermectin is effective against hookworm and avoids cross-reactivity with benzimidazoles. 1
• Before administering ivermectin, exclude Loa loa infection in patients from Central or West Africa, as ivermectin can precipitate fatal encephalopathy in co-infected individuals. 4, 5

Monitoring and Follow-Up

• For the standard 3-day albendazole course, no routine laboratory monitoring is required. 4
• If therapy extends beyond 14 days (rare for hookworm), obtain complete blood count and liver function tests every 2 weeks, as leukopenia occurs in 10% and elevated transaminases in 16% of patients. 4, 5
• Repeat stool examination 2–3 weeks post-treatment to confirm cure; persistent infection may indicate treatment failure or reinfection. 6

Critical Clinical Pitfalls

• Do not use single-dose albendazole for hookworm treatment, as cure rates are inadequate (36–69%); always prescribe the 3-day regimen. 1, 2, 3
• Avoid administering albendazole with mineral oil (liquid paraffin), as it significantly impairs drug absorption and reduces efficacy. 4
• In patients requiring long-term corticosteroids, screen for or empirically treat Strongyloides stercoralis before starting immunosuppression, as hyperinfection syndrome is fatal. 4, 5
• For heavy hookworm infections causing severe anemia, consider adding prednisolone 40–60 mg daily and seek specialist advice, as management may require intensive care. 1