Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

symptomatic patients + family members

1st line – anthelmintic

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ACUTE
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symptomatic patients + family members
1st line – 

anthelmintic

Anthelmintics should be given to kill adult worms residing in the gastrointestinal tract.

A single oral dose is administered at the time of diagnosis. As these drugs are not ovicidal, a second dose is indicated 2 weeks after the first.[1][16][22]​​​ Two-dose therapy achieves cure rates of greater than 90%.[6]

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. 

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

Primary options

mebendazole: children ≥2 years of age and adults: 100 mg orally as a single dose, may repeat in 2 weeks

OR

albendazole: children ≥2 years of age and adults: 400 mg orally as a single dose, may repeat in 2 weeks

Secondary options

pyrantel: 11 mg/kg orally as a single dose, maximum 1000 mg/dose; may repeat in 2 weeks

Plus – hygiene measures

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ACUTE
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symptomatic patients + family members
Plus – 

hygiene measures

Treatment recommended for ALL patients in selected patient group

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]​

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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