Medication Summary

The goals of pharmacotherapy are to eradicate infestation, to prevent complications, and to reduce morbidity.

Class Summary

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.

Albendazole (Albenza)

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First DOC. A benzimidazole carbamate drug that inhibits tubulin polymerization, resulting in degeneration of cytoplasmic microtubules. Decreases ATP production in worms, 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.

Well tolerated and does not appear to increase risk of worm obstruction.

Mebendazole (Emverm)

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Well tolerated and does not appear to increase risk of worm obstruction. Causes worm death by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where helminths dwell. Available as a 100-mg chewable tablet that can be swallowed whole, chewed, or crushed and mixed with food.

Pyrantel pamoate (Pin-Rid, Reese's Pinworm Medicine)

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Neuromuscular blocking agent used to slowly paralyze worm to be eliminated from GI tract. May be DOC during pregnancy.

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Media Gallery

Adult Ascaris lumbricoides.
Life cycle of Ascaris lumbricoides.
Ascaris lumbricoides egg.
Adult Ascaris lumbricoides in biliary system.
Life cycle of Ascaris lumbricoides. Courtesy of the Centers for Disease Control and Prevention (CDC) [https://www.cdc.gov/dpdx/ascariasis/index.html].
Larva of A lumbricoides hatching from an egg. Courtesy of the Centers for Disease Control and Prevention (CDC) [https://www.cdc.gov/dpdx/ascariasis/index.html].

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Author

Amber Mahmood Bokhari, MBBS Assistant Professor, Department of Infectious Disease, University of South Alabama College of Medicine

Amber Mahmood Bokhari, MBBS is a member of the following medical societies: American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

John A Vande Waa, DO, PhD Professor of Medicine and Director, Division of Infectious Diseases, Adjunct Associate Professor, Department of Microbiology and Immunology, University of South Alabama College of Medicine

John A Vande Waa, DO, PhD is a member of the following medical societies: American Federation for Medical Research, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard B Brown, MD, FACP Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

David R Haburchak, MD, FACP Key Faculty, Wellstar Kennestone Internal Medicine Residency Program, Wellstar Health System

David R Haburchak, MD, FACP is a member of the following medical societies: American College of Physicians, American Osler Society, American Society for Microbiology, Christian Medical and Dental Associations, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Jeffrey D Band, MD, FACP, FIDSA Professor of Medicine, Oakland University William Beaumont School of Medicine; Health System Chair, Healthcare Epidemiology and International Medicine, Beaumont Health System; Former Chief of Infectious Diseases, Beaumont Hospital; Clinical Professor of Medicine, Wayne State University School of Medicine

Disclosure: Nothing to disclose.