Approach

Anthelmintic therapy (e.g., mebendazole, albendazole, pyrantel) is indicated in all patients with evidence of pinworm infection. One dose sufficiently kills adult worms. However, these treatments do not destroy the eggs or larvae. Therefore, a second treatment 2 weeks later is recommended to eradicate worms from newly hatched eggs.[1][14][16][22]​​​ Because of the high transmissibility of pinworms, it is important to ensure that all household members are treated when there is an infected child in the home. Treatment should also be offered to exposed sexual partners.[16]

Pregnancy and children <2 years

There is a lack of safety data on the use of these drugs in pregnant women. Consider treatment if the infection is compromising pregnancy (e.g., weight loss). Treatment should be delayed until the third trimester, if possible. The World Health Organization allows use of these drugs in the second and third trimesters of pregnancy; however, they acknowledge that the risk of treatment needs to be balanced against the risk of disease progression in the absence of treatment.[23]

None of these drugs has been studied extensively in children younger than 2 years of age.[1][23] Consultation with an infectious disease specialist is recommended to weigh the risks and benefits of treatment in young children.

Prevention of spread and reinfection

Given the fecal-oral route of transmission, thorough hand hygiene is the most effective method of prevention.[16]​ Hand washing reduces autoinfection and transmission to household contacts, especially when food is being prepared or consumed. Children should be discouraged from sucking their thumbs, biting their nails, and scratching themselves. Keeping nails trimmed may also reduce the egg burden on fingers. Sheets and undergarments of infected individuals should be washed promptly and should not be shaken, in order to avoid dissemination of eggs. Infected individuals should shower every morning, should use a shower rather than a bath, and should not co-bathe with others.[1][16][24]

Recurrent infection

Recurrence is common, but is due to reinfection rather than poor efficacy of anthelmintic agents. Retreatment should be with the same agent.[1][16]

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