eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Enterobiasis: Treatment & Medication

Author: Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
Contributor Information and Disclosures

Updated: Nov 16, 2007

Treatment

Medical Care

  • Fear, disgust, and guilt are common parental reactions to parasitic worm infestation. Many families present to the emergency department or their pediatrician with misconceptions about pinworms. In addition to prescribing medications, educating families about pinworms (see Patient Education) is helpful.
  • Thorough and regular handwashing is effective in preventing disease transmission.

Medication

Mebendazole or albendazole are recommended as first-line treatment of pinworms. A second dose given 2 weeks after the initial dose helps prevent reoccurrences from reinfection.

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.

Anthelmintics

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 (Antiminth, Pin-Rid, 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.

Adult

11 mg/kg PO once; not to exceed 1 g; repeat treatment in 2 wk

Pediatric

Administer as in adults

Theophylline serum levels may increase in pediatric patients, following pyrantel pamoate administration

Documented hypersensitivity; hepatic disease

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in liver impairment, anemia, or malnutrition


Mebendazole (Vermox)

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

Adult

100 mg PO once; repeat treatment in 2 wk

Pediatric

Administer as in adults

Carbamazepine and phenytoin may decrease effects of mebendazole; cimetidine may increase mebendazole levels

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Adjust dose in hepatic impairment

More on Enterobiasis

Overview: Enterobiasis
Differential Diagnoses & Workup: Enterobiasis
Treatment & Medication: Enterobiasis
Follow-up: Enterobiasis
References
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References

  1. 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. May 2004;20(5):372-5. [Medline].

  2. American Academy of Pediatrics. Pinworm Infection (Enterobius vermicularis). Report of the committee on infectious disease. 2003;486-7.

  3. Hoekelman RA. Pinworm Infestation. In: Merck Manual of Diagnosis and Therapy. 15th ed. 1987.

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

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

  6. 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. Sep 2003;91(1):46-50. [Medline].

  7. 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. Oct 1950;50(4):475-516. [Medline].

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

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Further Reading

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Keywords

enterobiasis, pinworms, oxyuriasis, Enterobius vermicularis, E vermicularis, human pinworm, pinworm infection, pruritus ani, pruritus vulvae, vaginitis

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Contributor Information and Disclosures

Author

Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michael D Nissen, MBBS, BMedSc, 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, BMedSc, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Nothing to disclose.

Managing Editor

Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University
Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Professor and Vice Chairman, Department of Pediatrics, Head, Division of Infectious Diseases, Louisiana State University Health Sciences Center
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, and Southern Medical Association
Disclosure: None None None

 
 
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