Enterobiasis medical therapy
Template:PinwormEditor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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.
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. 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 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.
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.[1][2]
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.
Medical Therapy and Breast Feeding
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.
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.