Dracunculiasis Treatment & Management

Updated: Oct 14, 2023
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: Russell W Steele, MD  more...
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Medical Care

The mainstay of treatment is the extraction of the adult worm from the patient using a stick at the skin surface and wrapping or winding the worm a few centimeters per day. Because the worm can be as long as one meter in length, full extraction can take several days to weeks. This slow process is required to avoid breakage and leaving behind a portion of the worm.

Each day, the affected body part is immersed in a container of water to encourage more of the worm to come out. The wound is cleaned and gentle traction is applied to the worm to slowly pull it out. Pulling stops when resistance is met to avoid breaking the worm. The worm is wrapped around a stick to maintain some tension on the worm and encourage more of the worm to emerge. Topical antibiotics are applied to the wound to prevent secondary bacterial infections and the affected body part is then bandaged with fresh gauze to protect the site. These steps are repeated every day until the whole worm is successfully pulled out.

Analgesics, such as aspirin or ibuprofen, are given to help ease the pain of this process and reduce inflammation.

No specific drug is used to treat dracunculiasis. Metronidazole or thiabendazole (in adults) is usually adjunctive to stick therapy and somewhat facilitates the extraction process. However, one study found that antihelminthic therapy was associated with aberrant migration of worms, resulting in infection in areas other than the lower extremity. Therefore, such medications should be used with caution.


Surgical Care

The worm also can be excised surgically where such facilities are available.



Suspicion of dracunculiasis based on history or examination findings warrants consultation of an infectious disease specialist for involvement in management and follow-up care. This also allows for initiation of epidemiologic protocol if the patient presents in a nonendemic country.


Further Outpatient Care

Close follow-up monitoring is necessary to track progression of extraction in patients with dracunculiasis.

Initially, warm compresses may be useful in relieving pain.

Diligent cleaning of the wound site is necessary during and following extraction of the worm.

Topical antibiotic ointments, such as bacitracin or mupirocin (Bactroban), can be applied to wounds to prevent secondary infection.


Diet and Activity


No particular dietary changes are required during the extraction process, regardless of the time involved.


Activity is usually self-restricted because of discomfort. Recommendations are tailored for the individual, with no particular general guidelines.



No vaccine is available for dracunculiasis. Prevention of the disease is through the following:

  • Surveillance (case detection) and case containment

  • Provision of safe drinking water in endemic areas and filtering potentially contaminated water

  • Vector control using a chemical larvicide

  • Health education and community mobilization

Unfortunately, civil unrest and governmental lapses have prevented clearance of many water supplies in several endemic nations. Numerous positive social and political steps are also important to create conditions for the interruption of disease transmission.