eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Enterobiasis: Treatment & Medication

Author: Wayne Wolfram, MD, MPH,
Coauthor(s): Jennifer L Curry, DO, Resident Physician, Department of Emergency Medicine, St Vincent Mercy Medical Center
Contributor Information and Disclosures

Updated: Nov 9, 2009

Treatment

Medical Care

  • Fear, disgust, and guilt are common parental reactions to a parasitic worm infestation, such as enterobiasis. 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.

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.3

Ivermectin has been shown to have decreased efficacy as a single agent, compared with albendazole.4 However, it may possess efficacy when given as an adjunct.

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


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.

Adult

400 mg PO as single dose; repeat in 2 wk if necessary

Pediatric

<2 years: 200 mg PO as single dose; repeat in 2 wk if necessary
>2 years: Administer as in adults

Coadministration with carbamazepine may decrease efficacy; dexamethasone, cimetidine, and praziquantel may increase toxicity

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

Discontinue use if LFT results significantly increase (resume when levels decrease to pretest values); abdominal pain, nausea, vomiting, diarrhea, dizziness, vertigo, fever, increased intracranial pressure, and alopecia may occur

More on Enterobiasis

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

  1. [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].

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

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

  4. 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. Jun 2008;106(3):190-4. [Medline].

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

  6. 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].

  7. 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].

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

  9. American Academy of Pediatrics. Pinworm Infection (Enterobius vermicularis). Report of the committee on infectious disease. 2009;519-20.

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

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

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

  13. 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.

  14. 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].

  15. 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].

  16. 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, human pinworm, pinworm infection, pruritus ani, pruritus vulvae, vaginitis, enuresis, treatment, diagnosis

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Contributor Information and Disclosures

Author

Wayne Wolfram, MD, MPH, 
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.

Coauthor(s)

Jennifer L Curry, DO, Resident Physician, Department of Emergency Medicine, St Vincent Mercy Medical Center
Jennifer L Curry, DO is a member of the following medical societies: American College of Emergency Physicians, American Osteopathic Association, 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
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

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, Division 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 Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
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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