Enterobiasis medical therapy: Difference between revisions

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Latest revision as of 21:35, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S [2]

Overview

Antiparasitic drugs used for enterobiasis include either mebendazole (Vermox), albendazole, piperazine (Antepar), or pyrantel pamoate (Combatrin, Povan). A repeat dose is recommended two weeks after the initial treatment. More than one household member is likely to be infected, so the entire household is often treated.

Medical Therapy

Medication is the primary treatment for pinworm infection. However, reinfection is frequent regardless of the medication used. Also, if one household member spreads the eggs to another, it will be a matter of two or three weeks before those eggs become adult worms and thus amenable to treatment.
Asymptomatic infections, often in small children, can serve as reservoirs of infection, and therefore the entire household should be treated regardless of whether or not symptoms are present. Total elimination of the parasite in a household may require repeated doses of medication for up to a year or more. Because the drugs kill the adult pinworms, but not the eggs, the first retreatment is recommended in two weeks.

The medications usually used for the treatment of pinworm are:

Antimicrobial Regimen

Enterobius vermicularis^[1]

Preferred regimen (1): Albendazole 400 mg PO single dose
Preferred regimen (2): Mebendazole 100 mg PO single dose
Preferred regimen (3): Ivermectin 200 µg/kg PO single dose
Preferred regimen (4): Pyrantel pamoate 11 mg/kg up to 1.0 g PO single dose

Note: A second dose is given 2 weeks later. The second dose of medication is to eliminate possible re-infection or autoinfection. Health risks and benefits of these drugs for patients under 2 years of age should be considered.

Mechanism of action

Benzimidazole compounds
- The benzimidazole compounds albendazole (brand names e.g., Albenza, Eskazole, Zentel and Andazol) and mebendazole (brand names e.g., Ovex, Vermox, Antiox and Pripsen) are the most effective. They work by inhibiting the microtubule function in the pinworm adults, causing glycogen depletion, thereby effectively starving the parasite. A single 100-milligram dose of mebendazole with one repetition after a week is considered the safest and is usually effective with a cure rate of 96%. Mebendazole has no serious side effects, although abdominal pain and diarrhea have been reported.
Pyrantel pamoate
- Pyrantel pamoate (also called pyrantel embonate, brand names e.g., Reese's Pinworm Medicine, Pin-X, Combantrin, Anthel, Helmintox, and Helmex) kills adult pinworms through the neuromuscular blockade and is considered as effective as the benzimidazole compounds.
Other medications
- Piperazine causes flaccid paralysis in the adult pinworms and pyrvinium pamoate (also called pyrvinium embonate) works by inhibiting oxygen uptake of the adult pinworms.

Pinworms located in the genitourinary system (in this case, female genital area) may require other drug treatments.

References

↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

Template:WH Template:WS

[1] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[1]

@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Pinworm}}{{CMG}}
+{{Enterobiasis}}
+{{CMG}} {{AE}} {{MMF}}
 ==Overview==
-Treatment is straightforward in uncomplicated cases, however, elimination of the parasite from a family group or institution often poses significant problems—either due to an incomplete cure or reinfection. The condition can be treated with [[mebendazole]] (Vermox), [[albendazole]], [[piperazine]] (Antepar), or mostly commonly [[pyrantel pamoate]] (Combatrin, Povan). Taking a second dose of medication two weeks after the first will usually kill any pinworms that might have hatched in the meantime, before they are able to produce new eggs. More than one household member is likely to be infected, so the entire household is often treated.
+[[Antiparasitics|Antiparasitic drugs]] used for enterobiasis include either [[mebendazole]] (Vermox), [[albendazole]], [[piperazine]] (Antepar), or [[pyrantel pamoate]] (Combatrin, Povan). A repeat dose is recommended two weeks after the initial treatment. More than one household member is likely to be infected, so the entire household is often treated.
 ==Medical Therapy==
-The medications used for the treatment of  pinworm are [[mebendazole]], [[pyrantel pamoate]], and [[albendazole]]. All  three of these drugs are to be given in 1 dose at first and then another single  dose 2 weeks later. [[Pyrantel pamoate]] is available without  prescription. The second dose of medication is to eliminate possible  re-infection since the first dose of medication. Health practitioners and  parents should weigh the health risks and benefits of these drugs for patients  under 2 years of age.
+*[[Medication]] is the primary treatment for pinworm infection. However, reinfection is frequent regardless of the medication used. Also, if one household member spreads the eggs to another, it will be a matter of two or three weeks before those eggs become adult worms and thus amenable to treatment.
+*[[Asymptomatic]] infections, often in small children, can serve as reservoirs of infection, and therefore the entire household should be treated regardless of whether or not symptoms are present. Total elimination of the parasite in a household may require repeated doses of medication for up to a year or more. Because the drugs kill the adult pinworms, but not the eggs, the first retreatment is recommended in two weeks.
-[[Medication]] is the primary treatment for pinworm infection. The existing pharmaceutical drugs against pinworms are so effective that many medical scientists regard hygienic measures as impractical. However, reinfection is frequent regardless of the medication used. Total elimination of the parasite in a household may require repeated doses of medication for up to a year or more. Because the drugs kill the adult pinworms, but not the eggs, the first retreatment is recommended in two weeks. Also, if one household member spreads the eggs to another, it will be a matter of two or three weeks before those eggs become adult worms and thus amenable to treatment. [[Asymptomatic]] infections, often in small children, can serve as reservoirs of infection, and therefore the entire household should be treated regardless of whether or not symptoms are present.
+*The medications usually used for the treatment of pinworm are:
+**[[Mebendazole]]
+**[[Pyrantel pamoate]]
+**[[Albendazole]]
-The [[benzimidazole]] compounds [[albendazole]] (brand names e.g., ''Albenza'', ''Eskazole'', ''Zentel'' and ''Andazol'') and [[mebendazole]] (brand names e.g., ''Ovex'', ''Vermox'', ''Antiox'' and ''Pripsen'') are the most effective. They work by inhibiting the [[microtubule]] function in the pinworm adults, causing [[glycogen]] depletion, thereby effectively starving the parasite. A single 100 milligram dose of [[mebendazole]]  with one repetition after a week, is considered the safest, and is usually effective with cure rate of 96%. Mebendazole has no serious [[side effects]], although [[abdominal pain]] and [[diarrhea]] have been reported. [[Pyrantel pamoate]] (also called pyrantel embonate, brand names e.g., ''Reese's Pinworm Medicine'', ''Pin-X'', ''Combantrin'', ''Anthel'', ''Helmintox'', and ''Helmex'') kills adult pinworms through neuromuscular blockade, and is considered as effective as the [[benzimidazole]] compounds. Other medications are [[piperazine]], which causes [[flaccid paralysis]] in the adult pinworms, and pyrvinium pamoate (also called pyrvinium embonate), which works by inhibiting [[oxygen]] uptake of the adult pinworms. Pinworms located in the [[genitourinary system]] (in this case, female genital area) may require other drug treatments.
+===Antimicrobial Regimen===
+*''' Enterobius vermicularis'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-A pinworm infection can also be treated using home made remedies and the most common ingredients used are tea tree oil, garlic, papaya seeds, and pumpkin seeds. Usually smashed garlic cloves and tea tree oil mixture are applied around the anus to kill the female pinworms and destroy the eggs.<ref>http://www.pinworms.co/treatments-for-pinworms/</ref><ref>http://www.healthguidance.org/entry/15625/1/Home-Remedies-for-Pinworms.html</ref>
+:* Preferred regimen (1): [[Albendazole]] 400 mg PO single dose
+:* Preferred regimen (2): [[Mebendazole]] 100 mg PO single dose
-Repeated infections should be treated by the  same method as the first infection. In households where more than one member is infected or where repeated, symptomatic infections occur, it is recommended that all household members be treated at the same time. In institutions, mass and simultaneous treatment, repeated in 2 weeks, can be effective.
+:* Preferred regimen (3): [[Ivermectin]] 200 µg/kg PO single dose
+:* Preferred regimen (4): [[Pyrantel pamoate]] 11 mg/kg up to 1.0 g PO single dose
-===Medical Therapy and Breast Feeding===
+*Note: A second dose is given 2 weeks later. The second dose of medication is to eliminate possible re-infection or autoinfection. Health risks and benefits of these drugs for patients under 2 years of age should be considered.
-The safety of drugs used to treat pinworm have not been studied for pregnant women. If the infection is compromising the pregnancy (i.e. [[weight  loss]], sleeplessness) then treatment can be considered, but should be withheld  until the 3rd trimester when the risk, if any, to the fetus is likely  to be reduced.
+===Mechanism of action===
+#Benzimidazole compounds
-Breastfeeding should not be withheld during [[mebendazole]] therapy. Only  about 2%-10% of an oral dose is absorbed and as expected, the amounts of the drug excreted in milk are below the level of detection and appear to be clinically insignificant. Excretion in breast milk of the other drugs used to treat pinworm is not as well characterized.
+#*The [[benzimidazole]] compounds [[albendazole]] (brand names e.g., ''Albenza'', ''Eskazole'', ''Zentel'' and ''Andazol'') and [[mebendazole]] (brand names e.g., ''Ovex'', ''Vermox'', ''Antiox'' and ''Pripsen'') are the most effective. They work by inhibiting the [[microtubule]] function in the pinworm adults, causing [[glycogen]] depletion, thereby effectively starving the parasite. A single 100-milligram dose of [[mebendazole]] with one repetition after a week is considered the safest and is usually effective with a cure rate of 96%. Mebendazole has no serious [[side effects]], although [[abdominal pain]] and [[diarrhea]] have been reported.
+#Pyrantel pamoate
+#*[[Pyrantel pamoate]] (also called pyrantel embonate, brand names e.g., ''Reese's Pinworm Medicine'', ''Pin-X'', ''Combantrin'', ''Anthel'', ''Helmintox'', and ''Helmex'') kills adult pinworms through the neuromuscular blockade and is considered as effective as the [[benzimidazole]] compounds.
+#Other medications
+#*[[Piperazine]] causes [[flaccid paralysis]] in the adult pinworms and pyrvinium pamoate (also called pyrvinium embonate) works by inhibiting [[oxygen]] uptake of the adult pinworms.
+Pinworms located in the [[genitourinary system]] (in this case, female genital area) may require other drug treatments.
 ==References==
 {{reflist|2}}
+{{WH}}
+{{WS}}
 [[Category:Disease]]
 [[Category:Parasites]]
 [[Category:Nematodes]]
 [[Category:Proctology]]
+[[Category:Pediatrics]]
+[[Category:Emergency medicine]]
+[[Category:Up-To-Date]]
 [[Category:Infectious disease]]
-[[Category:Pediatrics]]
+[[Category:Gastroenterology]]
-{{WH}}
-{{WS}}