Treatment

Treatment is most important for children with heavy infections and with clinical symptoms. The aim of treatment is to reduce the number of worms so symptoms will disappear. Piperazine, pyrantel embonate, and mebendazole are some of the drugs recommended for treatment (Cook 1994; Gan et al. 1994;

Conners 1995; Venkatesan 1998). Mebendazole is usually preferred since the drug has a low intestinal absorption allowing for equal doses to be used in children and adults with a satisfactory effect on the worm load. In addition, there are seldom any significant side effects. Albendazole is perhaps even more potent and is sometimes recommended as a second line drug. Neither albendazole nor mebendazole should be given during pregnancy while pyrantel embonate could be used safely in pregnant women. Most often, treatment is given with single doses of mebendazole, 100mg, to all members of a family and an additional dose 1 week later is often recommended. To remove eggs from the surroundings, a change of bed- and night-clothes may be performed. However, hygienic

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measures should not be used in excess. Whatever measures are taken, re-infections are common, especially in children attending nurseries or other institutions. A recent Swedish study reported a prevalence of 27% pin worm infections in children in three different nurseries (Kjellberg and Heyman 1993). With rigorous hygienic measures in the form of intense cleaning of floors, of walls and of toys, the prevalence could be reduced only down to 7%. As no children had any symptoms the usefulness of these strong efforts, was questioned by the authors.

Thus, physicians should remember that enterobiasis is usually an innocent infection, but often difficult to eradicate. Too much attention with rigorous hygiene and repeated treatments may not lead to eradication, but to increasing psychological problems in the affected family. Drug treatment shall mainly be given when symptoms occur and after treatment the worm should be given no further attention.

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