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Enterobiasis Medication

  • Author: Wayne Wolfram, MD, MPH; Chief Editor: Russell W Steele, MD  more...
 
Updated: Apr 27, 2016
 

Medication Summary

Mebendazole is not currently available in the United States. Pyrantel pamoate or albendazole (not currently approved for this use by the US Food and Drug Administration) are recommended alternatives. A second dose given 2 weeks after the initial dose is recommended.[10]

Because asymptomatic infestation of other members in a household is frequent, simultaneously treating all household members may be reasonable. Families should be informed that repeat infestations are common. Reinfestation is treated with the same medications as the initial infestation.

Symptomatic relief of pruritus can be obtained by applying an antipruritic ointment or cream topically to the affected (usually perianal) region.

Anal albendazole may help with symptoms of pruritus ani. A recent letter to the editor stated a “local application of albendazole using an ear bud soaked with the residual albendazole suspension in the vial” in addition to the recommended oral dose of albendazole provided dramatic relief of pruritus ani.[11]

Ivermectin has been shown to have decreased efficacy as a single agent, compared with albendazole.[12] However, it may possess efficacy when given as an adjunct.

 

 

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Anthelmintics

Class Summary

Parasite biochemical pathways are different from the human host, thus toxicity is directed to the parasite, egg, or larvae. Mechanism of action varies within the drug class.

Pyrantel pamoate (Pamix, Reeses Pinworm Medicine, Pin-X)

 

Depolarizing neuromuscular blocking agent and inhibits cholinesterases, resulting in spastic paralysis of the worm. Purging not necessary. May be taken with milk or fruit juices.

Mebendazole

 

Causes worm death by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where helminths dwell.

Albendazole (Albenza)

 

A benzimidazole carbamate drug that inhibits tubulin polymerization, resulting in degeneration of cytoplasmic microtubules. Decreases ATP production in worm, causing energy depletion, immobilization, and finally death. Converted in the liver to its primary metabolite, albendazole sulfoxide. Less than 1% of the primary metabolite is excreted in the urine. Plasma level is noted to rise significantly (as much as 5-fold) when ingested after high-fat meal. Experience with patients < 6 y is limited.

To avoid inflammatory response in CNS, patient must also be started on anticonvulsants and high-dose glucocorticoids.

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Contributor Information and Disclosures
Author

Wayne Wolfram, MD, MPH Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Steven Indra, DO Emergency Medicine Physician, Mercy Health System

Steven Indra, DO is a member of the following medical societies: American Medical Association, American Osteopathic Association, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Lukuman Olumide Afuwape, MD Resident Physician, Department of Emergency Medicine, Mercy St Vincent Medical Center

Lukuman Olumide Afuwape, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Michael D Nissen, MBBS FRACP, FRCPA, Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital

Michael D Nissen, MBBS is a member of the following medical societies: American Academy of Pediatrics, Royal College of Pathologists of Australasia, Royal Australasian College of Physicians, American Society for Microbiology, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Jennifer A Curry, MD, MPH Attending Physician, Infectious Disease Clinic, Naval Medical Center Portsmouth; Assistant Professor of Medicine, Uniformed Services University of the Health Sciences

Jennifer A Curry, MD, MPH is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References
  1. Centers for Disease Control and Prevention. Enterobiasis. Available at http://www.dpd.cdc.gov/dpdx/HTML/Enterobiasis.htm. Accessed: June 17, 2013.

  2. Salim N, Schindler T, Abdul U, Rothen J, Genton B, Lweno O, et al. Enterobiasis and strongyloidiasis and associated co-infections and morbidity markers in infants, preschool- and school-aged children from rural coastal Tanzania: a cross-sectional study. BMC Infect Dis. 2014 Dec 9. 14:644. [Medline].

  3. Song HJ, Cho CH, Kim JS, Choi MH, Hong ST. Prevalence and risk factors for enterobiasis among preschool children in a metropolitan city in Korea. Parasitol Res. 2003 Sep. 91(1):46-50. [Medline].

  4. Kim DH, Son HM, Kim JY, Cho MK, Park MK, Kang SY, et al. Parents' knowledge about enterobiasis might be one of the most important risk factors for enterobiasis in children. Korean J Parasitol. 2010 Jun. 48(2):121-6. [Medline].

  5. Fontanet AL, Sahlu T, Rinke de Wit T, et al. Epidemiology of infections with intestinal parasites and human immunodeficiency virus (HIV) among sugar-estate residents in Ethiopia. Ann Trop Med Parasitol. 2000 Apr. 94(3):269-78. [Medline].

  6. Centers for Disease Control and Prevention. Pinworms. Available at http://www.cdc.gov/parasites/pinworm/epi.html. Accessed: June 17, 2013.

  7. [Guideline] American College of Obstetricians and Gynecologists (ACOG). Vaginitis. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2006 May. 12 p. (ACOG practice bulletin; no. 72). [Full Text].

  8. Ariyarathenam AV, Nachimuthu S, Tang TY, et al. Enterobius vermicularis infestation of the appendix and management at the time of laparoscopic appendectomy: case series and literature review. Int J Surg. 2010. 8(6):466-9. [Medline].

  9. Snow M. Pinning down pinworms. Nursing. 2006 May. 36(5):17. [Medline].

  10. American Academy of Pediatrics. Pinworm Infection (Enterobius vermicularis). Report of the committee on infectious disease. 2015. 621-22.

  11. Singh SP, Panda C, Rout N, Mishra AP. Anal Albendazole application for pruritus ani in threadworm infestation. J Trop Pediatr. 2005 Dec. 51(6):386. [Medline].

  12. Wen LY, Yan XL, Sun FH, Fang YY, Yang MJ, Lou LJ. A randomized, double-blind, multicenter clinical trial on the efficacy of ivermectin against intestinal nematode infections in China. Acta Trop. 2008 Jun. 106(3):190-4. [Medline].

  13. Ramezani MA, Dehghani MR. Relationship between Enterobius vermicularis and the incidence of acute appendicitis. Southeast Asian J Trop Med Public Health. 2007 Jan. 38(1):20-3. [Medline].

  14. Sodergren MH, Jethwa P, Wilkinson S, Kerwat R. Presenting features of Enterobius vermicularis in the vermiform appendix. Scand J Gastroenterol. 2009. 44(4):457-61. [Medline].

  15. Vose L. Pinworm in pregnancy. J Midwifery Womens Health. 2012 Mar-Apr. 57(2):184-7. [Medline].

  16. Arca MJ, Gates RL, Groner JI, Hammond S, Caniano DA. Clinical manifestations of appendiceal pinworms in children: an institutional experience and a review of the literature. Pediatr Surg Int. 2004 May. 20(5):372-5. [Medline].

  17. Samkari A, Kiska DL, Riddell SW, et al. Dipylidium caninum mimicking recurrent enterobius vermicularis (pinworm) infection. Clin Pediatr (Phila). 2008 May. 47(4):397-9. [Medline].

  18. Hoekelman RA. Pinworm Infestation. Merck Manual of Diagnosis and Therapy. 15th ed. 1987.

  19. Kucik CJ, MartinGL, Sortor BV. Common Intestinal Parasites. Am Fam Physician. Mar 2004. 69(5):11621-8.

  20. Lormans JA, Wesel AJ, Vanprus OF. Mebendazole in enterobiasis. A clinical trial in mental retardates. Chemotherapy. 1975. 21:255.

  21. McCarthy J, Loukas A, Hotez PJ. Chemotherapy of Helminth Infections. Brunton LL, Chabner BA, Knollmann BC, eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 12th ed. New York, NY: McGraw-Hill; 2011. Chapter 51.

  22. Otu-Bassey IB, Ejezie GC, Epoke J, Useh. Enterobiasis and its relationship with anal itching and enuresis among school-age children in Calabar, Nigeria. Ann Trop Med Parasitol. Sep 2005. 99(6):611-6.

  23. Song HJ, Cho CH, Kim JS, et al. Prevalence and risk factors for enterobiasis among preschool children in a metropolitan city in Korea. Parasitol Res. 2003 Sep. 91(1):46-50. [Medline].

  24. Symmers WS. Pathology of oxyuriasis; with special reference to granulomas due to the presence of Oxyuris vermicularis (Enterobius vermicularis) and its ova in the tissues. AMA Arch Pathol. 1950 Oct. 50(4):475-516. [Medline].

  25. Weller TH, Sorenson CW. Enterobiasis: Its incidence and symptomatology in a group of 505 children. NEJM. 1941. 224:143.

 
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Because of the short incubation time until the ova are infectious, eggs that are deposited under the fingernails during scratching and then placed in the mouth may be a mode of reinfestation.
 
 
 
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