Medication Summary
The goals of pharmacotherapy are to eradicate the infestation, reduce morbidity, and prevent complications. It is important to empirically cover the entire household simultaneously for pinworms when a decision is made to treat. Anthelmintics, such as mebendazole, pyrantel pamoate, and albendazole, are active against Enterobius vermicularis. Itching, irritation, and excoriation should be treated symptomatically. [1, 2]
Reinfection with E vermicularis immediately after the completion of drug therapy is common. Additionally, young pinworms may be resistant to drugs. [12] Successful eradication of pinworm infection, also called enterobiasis, requires two doses of medication - an initial dose followed by a subsequent dose 2 weeks later. [1, 2, 13]
Anthelmintics
Class Summary
Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.
Mebendazole
Mebendazole causes worm death by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where helminths dwell.
Pyrantel pamoate (Reese's Pinworm Medicine, Pin-X)
Pyrantel pamoate is a depolarizing neuromuscular blocking agent. It inhibits cholinesterases, resulting in spastic paralysis of the worm.
Albendazole (Albenza)
Albendazole decreases ATP production in worms, causing energy depletion, immobilization, and, finally, death. To avoid inflammatory responses in the CNS, patients must also be started on anticonvulsants and high-dose glucocorticoids.
-
Adult female worms of Enterobius vermicularis collected from a 2-year-old girl in a Korean orphanage after treatment with pyrantel pamoate 10 mg/kg.
-
Microscopic view of Enterobius vermiculariseggs attached to cellophane tape after a perianal swab from a child in kindergarten in Seoul, Korea. Egg size was 50-60 μm X 20-30 μm. The eggs are elongated and ovoid, distinctly compressed laterally, and flattened on one side.
-
Pinworms in a young patient.
