Enterobiasis (Pinworm Infestation) Medication: Anthelmintics (2024)

Mebendazole is not currently available in the United States. Pyrantel pamoate or albendazole (not currently approved for this use by the US Food and Drug Administration)are recommended alternatives.A second dose given 2 weeks after the initial dose is recommended. ^[16]

Because asymptomatic infestation of other members in a household is frequent, simultaneously treating all household members may be reasonable. Families should be informed that repeat infestations are common. Reinfestation is treated with the same medications as the initial infestation.

Symptomatic relief of pruritus can be obtained by applying an antipruritic ointment or cream topically to the affected (usually perianal) region.

Anal albendazole may help with symptoms of pruritus ani. A recent letter to the editor stated a “local application of albendazole using an ear bud soaked with the residual albendazole suspension in the vial” in addition to the recommended oral dose of albendazole provided dramatic relief of pruritus ani. ^[2]

Ivermectin has been shown to have decreased efficacy as a single agent, compared with albendazole. ^[17] However, it may possess efficacy when given as an adjunct.

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Class Summary

Parasite biochemical pathways are different from the human host, thus toxicity is directed to the parasite, egg, or larvae. Mechanism of action varies within the drug class.

Pyrantel pamoate (Pamix, Reeses Pinworm Medicine, Pin-X)

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Depolarizing neuromuscular blocking agent and inhibits cholinesterases, resulting in spastic paralysis of the worm. Purging not necessary. May be taken with milk or fruit juices.

Mebendazole

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Causes worm death by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where helminths dwell.

Albendazole (Albenza)

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A benzimidazole carbamate drug that inhibits tubulin polymerization, resulting in degeneration of cytoplasmic microtubules. Decreases ATP production in worm, causing energy depletion, immobilization, and finally death. Converted in the liver to its primary metabolite, albendazole sulfoxide. Less than 1% of the primary metabolite is excreted in the urine. Plasma level is noted to rise significantly (as much as 5-fold) when ingested after high-fat meal. Experience with patients < 6 y is limited.

To avoid inflammatory response in CNS, patient must also be started on anticonvulsants and high-dose glucocorticoids.

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Wayne Wolfram, MD, MPH Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Lukuman Olumide Afuwape, MD Resident Physician, Department of Emergency Medicine, Mercy St Vincent Medical Center

Lukuman Olumide Afuwape, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Steven Indra, DO Emergency Medicine Physician, Mercy Health System

Steven Indra, DO is a member of the following medical societies: American Medical Association, American Osteopathic Association, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Michael D Nissen, MBBS FRACP, FRCPA, Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital

Michael D Nissen, MBBS is a member of the following medical societies: American Academy of Pediatrics, Royal College of Pathologists of Australasia, Royal Australasian College of Physicians, American Society for Microbiology, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Jennifer A Curry, MD, MPH Attending Physician, Infectious Disease Clinic, Naval Medical Center Portsmouth; Assistant Professor of Medicine, Uniformed Services University of the Health Sciences

Jennifer A Curry, MD, MPH is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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