Key points
- Soil-transmitted helminths, including ascariasis, whipworm, and hookworm, are treatable with medication.
- Treatment is highly effective and can last 1 – 3 days.
- Dosage guidelines are the same for adults and children.
Treatment options
Oral albendazole, oral mebendazole, oral ivermectin, and oral pyrantel pamoate are available for human use in the United States. The safety of ivermectin for children weighing less than 15 kg (33 lbs) is unclear. The FDA has not approved albendazole as a treatment for ascariasis nor hookworm infection. The FDA has not approved albendazole nor ivermectin for treating whipworm infection.
Condition
Drug
Dosage
Ascariasis
Albendazole*
400 mg orally once. Take with food.
Mebendazole
100 mg orally twice daily for 3 days or 500 mg orally once.
Ivermectin
150 – 200 mcg/kg orally once. Take with water on an empty stomach.
Whipworm
Albendazole**
400 mg orally once daily for 3 days. Take with food.
Mebendazole
100 mg orally twice a day for 3 days.
Ivermectin**
200 mcg/kg/day orally for 3 days. Take with water on an empty stomach.
Hookworm
Albendazole*
400 mg orally once. Take with food.
Mebendazole
100 mg orally twice daily for 3 days or 500 mg orally once.
Pyrantel pamoate
11 mg/kg (up to maximum of 1 g) orally for three days.
*Not FDA-approved as a treatment for ascariasis or hookworm infection.
**Not FDA-approved as a treatment for whipworm infection.
Care precautions
Treatment in Pregnancy
Albendazole is a pregnancy category C drug. There are limited data on the use of albendazole in pregnant women. The available evidence suggests no difference in congenital abnormalities in the children of women accidentally treated with albendazole during mass drug administration (MDA) campaigns compared with those who were not. In MDA campaigns in countries where soil-transmitted helminths are common, the World Health Organization (WHO) determined that the benefits of treatment outweigh the risks. WHO allows use of albendazole in the 2nd and 3rd trimesters of pregnancy in these campaigns. However, in pregnant women infected with a soil transmitted helminth, balance the risks of treatment for the fetus with the risks of disease progression in the woman in the absence of treatment.
Pregnancy Category C: Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal, or other) plus there are no controlled studies in women, or studies in women and animals are not available. Prescribe albendazole only if the potential benefits to the woman justify the potential risks to the fetus.
Treatment during lactation
Albendazole is minimally excreted in human milk. WHO has concluded that a single oral dose of albendazole can be given to lactating women.
Treatment in pediatric patients
The safety of albendazole in children less than 6 years old is not certain. Studies of the use of albendazole in children as young as one year old suggest that it is safe. According to WHO guidelines for MDA campaigns, children as young as one year of age (able to safely swallow tablets) can take albendazole. These campaigns have treated many children under six years old with albendazole, albeit at a reduced dose.
Treatment in Pregnancy
Mebendazole is a pregnancy category C drug. Data on the use of mebendazole in pregnant women are limited. The available evidence suggests no difference in congenital anomalies in the children of women treated with mebendazole during mass drug administration (MDA) campaigns compared with those who were not. In mass drug administration programs in countries where soil-transmitted helminths are common, World Health Organization (WHO) has determined that the benefits of treatment outweigh the risks and WHO allows use of mebendazole in the 2nd and 3rd trimesters of pregnancy. However, in a pregnant woman infected with a soil-transmitted helminth, balance the risks of treatment for the fetus with the risks of disease progression in the woman in the absence of treatment.
Pregnancy Category C: Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal, or other) plus there are no controlled studies in women, or studies in women and animals are not available. Prescribe mebendazole only if the potential benefits to the woman justify the potential risks to the fetus.
Treatment during lactation
Mebendazole is minimally excreted in breast milk. WHO classifies mebendazole as compatible with breastfeeding and allows its use in lactating women.
Treatment in pediatric patients
The safety of mebendazole in children is unclear. There are limited data in children under 2 years old. The WHO Model List of Essential Medicines for Children lists mebendazole as an intestinal antihelminthic medicine that can be used for children older than 2 years of age.
Treatment in Pregnancy
Ivermectin is a pregnancy category C drug. Data on the use of ivermectin in pregnant women are limited, though the available evidence suggests no difference in congenital abnormalities in the children of women who were accidentally treated during mass drug administration campaigns with ivermectin compared with those who were not. The World Health Organization (WHO) excludes pregnant women from mass drug administration campaigns that use ivermectin. In a pregnant woman infected with a soil-transmitted helminth, balance the risks of treatment for the fetus with the risks of disease progression in the woman in the absence of treatment.
Pregnancy Category C: Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal, or other) plus there are no controlled studies in women, or studies in women and animals are not available. Prescribe ivermectin only if the potential benefits in the woman justify the potential risks to the fetus.
Treatment during lactation
Ivermectin is excreted in low concentrations in human milk. Treat breastfeeding women with ivermectin only when the risks of disease progression in the untreated mother outweigh the risks to the infant.
Treatment in pediatric patients
The safe use of ivermectin in children weighing less than 15 kg (33 lbs) is unclear. According to the WHO guidelines for mass drug administration campaigns, ivermectin can safely treat children at least 90 cm (35 in) tall. The WHO growth standard curves show that 50% of boys reach this height by age 28 months and 50% of girls by age 30 months. Some mass drug administration campaigns use ivermectin to treat younger children who are able to swallow tablets safely, albeit at a reduced dose.
Treatment in Pregnancy
Pyrantel pamoate is pregnancy category C. Data on the use of ivermectin in pregnant women are limited. In mass treatment programs for which the World Health Organization (WHO) has determined that the benefits of treatment outweigh the risks, WHO allows use of pyrantel pamoate in the 2nd and 3rd trimesters of pregnancy. However, in a pregnant woman infected with a soil-transmitted helminth, balance the risks of treatment for the fetus with the risks of disease progression in the woman the absence of treatment.
Pregnancy Category C: Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal, or other) plus there are no controlled studies in women, or studies in women and animals are not available. Prescribe pyrantel pamoate only if the potential benefits justify the potential risks to the fetus.
Treatment during lactation
It is not known whether pyrantel pamoate is excreted in breast milk. The WHO classifies pyrantel pamoate as compatible with breastfeeding, although data on the use of pyrantel pamoate during lactation are limited.
Treatment in pediatric patients
The safety of pyrantel pamoate in children is unclear. According to the WHO guidance on preventative chemotherapy, children aged one year and older may use pyrantel during mass treatment programs without diagnosis. The WHO Model List of Essential Medicines for Children lists pyrantel pamoate as an intestinal anthelminthic medicine that can be use in children one year of age and older.