What are the recommended treatment regimens for hookworm, tapeworm, and pinworm infections, including dosing for adults, children, pregnant or lactating patients, and those with drug intolerance?

Treatment of Hookworm, Tapeworm, and Pinworm Infections

Albendazole 400 mg as a single oral dose is the first-line treatment for pinworm and tapeworm infections, while hookworm requires albendazole 400 mg daily for 3 consecutive days to achieve optimal cure rates. 1

Pinworm (Enterobius vermicularis) Treatment

Standard Regimen

• Albendazole 400 mg orally as a single dose, repeated exactly 2 weeks later is the recommended treatment for all patients older than 24 months 1
• The two-dose schedule is mandatory because eggs present at the first dose hatch into new adult worms within 2-4 weeks, and the second dose eliminates these newly emerged parasites 1
• Mebendazole 100 mg as a single dose, repeated in 2 weeks is an equally effective alternative 2, 3

Pediatric Considerations

• Children older than 24 months receive the same 400 mg albendazole dose as adults 1
• Children 12-24 months may receive 400 mg albendazole, but only after expert consultation to ensure appropriateness 1

Environmental Decontamination

• On each treatment day, thoroughly vacuum bedroom floors and furniture to remove contaminating pinworm eggs from surfaces 1
• Clean bathroom fixtures—especially toilet seats and door handles—on treatment days to reduce environmental reservoirs and prevent reinfection 1

Pregnancy and Lactation

• Pyrantel pamoate (11 mg/kg, maximum 1 g) as a single dose repeated in 2 weeks is preferred over albendazole or mebendazole during pregnancy 3

Hookworm (Ancylostoma duodenale, Necator americanus) Treatment

Standard Regimen

• Albendazole 400 mg orally once daily for 3 consecutive days achieves cure rates of 92-97% and egg-reduction rates of 99.7-99.8%—substantially higher than single-dose therapy 1, 4
• This 3-day regimen is required for otherwise healthy individuals older than 2 years 1

Alternative Regimens

• Mebendazole 100 mg orally twice daily for 3 consecutive days is an effective alternative 2, 5
• For patients with documented benzimidazole hypersensitivity, ivermectin 200 µg/kg as a single dose, repeated after 2 weeks provides effective anti-hookworm activity without cross-reactivity 1
• Pyrantel pamoate 11 mg/kg (maximum 1 g) as a single dose is another alternative 5

Special Populations

• Pregnant women with severe hookworm-related anemia: prioritize iron supplementation as the primary intervention while deferring antiparasitic therapy until after delivery if possible 1
• Malnourished children: nutritional rehabilitation and iron supplementation should be prioritized alongside the standard albendazole regimen, as these patients are at increased risk for severe anemia 1

Severe Anemia Management

• In cases of heavy hookworm infection causing severe anemia, adding prednisolone 40-60 mg daily may be considered, with specialist consultation recommended for possible intensive-care management 1

Tapeworm (Taenia species, Hymenolepis nana) Treatment

Standard Regimen

• Albendazole 400 mg orally once daily for 3 consecutive days is the recommended treatment for intestinal tapeworm infections 1, 6
• This regimen achieves an overall cure rate of 85% for Taenia species and 68% for H. nana 4

Alternative Regimen

• Mebendazole 100 mg orally twice daily for 3 consecutive days is an effective alternative 2

Administration Requirements for All Helminth Infections

Critical Administration Guidelines

• Albendazole must always be taken with food, preferably a fatty meal, to maximize absorption 1
• Avoid liquid paraffin (mineral oil) during treatment as it significantly impairs albendazole absorption 1
• Mebendazole tablets may be chewed, swallowed, or crushed and mixed with food 2

Monitoring Requirements

• For treatment courses ≤14 days: no routine laboratory monitoring is necessary 1
• For treatment courses >14 days: perform complete blood count and liver function tests at the start of each 28-day cycle and every 2 weeks during therapy 1
• Leukopenia occurs in up to 10% of patients and elevated liver enzymes in up to 16% with prolonged treatment 1

Treatment Failure and Retreatment

When to Retreat

• If the patient is not cured 3 weeks after treatment, administer a second full course 2
• For pinworm, recurrences are common due to repeated cycles of reinfection (particularly autoinfection) because of the short life span of adult pinworms 3

Household Treatment

• Treatment of all household members should be considered for pinworm infections, especially if there are multiple or repeated symptomatic infections, because reinfection is common even when effective medication is given 3

Drug Intolerance and Contraindications

Absolute Contraindications

• Active hepatic disease: avoid albendazole due to risk of hepatotoxicity 1
• Pre-existing leukopenia: monitor blood counts closely because albendazole can cause leukopenia in up to 10% of patients 1

Pregnancy Considerations

• Use albendazole only when therapeutic benefit clearly outweighs potential fetal risk 1
• Pyrantel pamoate is the preferred agent during pregnancy for all three helminth infections 3

Common Pitfalls to Avoid

• Do not use single-dose albendazole for hookworm—the 3-day regimen is essential for adequate cure rates 1, 4
• Do not forget the second dose at 2 weeks for pinworm—this is mandatory to eliminate newly hatched larvae 1
• Do not examine stool for pinworm diagnosis—the perianal adhesive tape test is the preferred diagnostic method, as pinworms and eggs are not usually passed in stool 1, 3
• Do not skip environmental decontamination for pinworm—cleaning on treatment days significantly reduces reinfection risk 1