# Intestinal helminths - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: CDC Yellow Book 2024 · DailyMed Mebendazole Chewable Tablet Package Insert, SetID 211116b4-2394-47c0-8438-bb4e578f2441 · Egyptian National Drug Formulary - Antimicrobial 2023 (ivermectin monograph) · WHO Human Helminthiasis 2017 - Verified date: 2026-08 ## Verified against - DailyMed Mebendazole Chewable Tablet Package Insert, SetID 211116b4-2394-47c0-8438-bb4e578f2441 - Egyptian National Drug Formulary - Antimicrobial 2023 (ivermectin monograph) - WHO Human Helminthiasis 2017 - Ascariasis - StatPearls disease-level clinical article, filed as intestinal-helminths-clinical.txt ## Treatment metadata - Mebendazole — 100 mg — oral.solid - Albendazole — 400 mg — oral.solid - Referral & safety-netting (no drug therapy) - Ivermectin — 6 mg — oral.solid ## Complete treatment card ```text INTESTINAL HELMINTHS Sources: CDC Yellow Book 2024 · DailyMed Mebendazole Chewable Tablet Package Insert, SetID 211116b4-2394-47c0-8438-bb4e578f2441 · Egyptian National Drug Formulary - Antimicrobial 2023 (ivermectin monograph) · WHO Human Helminthiasis 2017 Review status: REVIEWED against DailyMed Mebendazole Chewable Tablet Package Insert, SetID 211116b4-2394-47c0-8438-bb4e578f2441, Egyptian National Drug Formulary - Antimicrobial 2023 (ivermectin monograph), WHO Human Helminthiasis 2017, Ascariasis - StatPearls disease-level clinical article, filed as intestinal-helminths-clinical.txt (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Most people with roundworm infection have no symptoms or only mild, nonspecific complaints, tracking with how many worms are present - Low-level infection can stay silent apart from long-term growth retardation and malnutrition, especially in children - When present, GI complaints include abdominal pain, bloating, nausea, vomiting, loss of appetite, and intermittent diarrhea [abdominal distension · abdominal pain · diarrhoea · nausea · poor appetite · vomiting] - Heavy larval lung burden during migration can trigger transient eosinophilic pneumonitis with cough, wheeze, breathlessness, fever, and coughed-up blood [breathlessness · cough · fever · wheeze] - Affected children tend to fare worse, developing failed growth, malnutrition, belly pain, loose stools, and nausea [abdominal pain · diarrhoea · nausea] - Migrating adult worms can obstruct the bile duct, pancreatic duct, or bowel - causing biliary colic, cholangitis, pancreatitis, bowel obstruction, volvulus, appendicitis, or intussusception [abdominal pain · volvulus] SIGNS - what you find (1) - Adult worms are sometimes seen directly - passed in stool, expelled from the rectum, or coughed up TESTS (11) - Female worms shed up to 200,000 eggs daily, which is why stool testing is so effective for detection - Stool microscopy for ova and parasites is the mainstay of diagnosis - Two slides per sample are examined, looking for large, oval, brown, three-layered eggs with a bumpy outer shell - WHO recommends the Kato-Katz thick smear in endemic areas to both diagnose and quantify infection intensity, though it has real limits, especially in light infections - In one Kenyan field study, Kato-Katz microscopy picked up only 54% to 64% of infections, missing many mild or prepatent cases - Multiplex real-time PCR was markedly more sensitive than microscopy and served as the reference standard in that study - IgG1 antibody testing against adult-worm secretions was highly specific and sensitive for active infection, with an AUC near 0.83 - Stool testing can be falsely negative in the first 3 to 4 weeks after infection, before egg- laying begins - During the larval migratory phase, blood eosinophilia may be the clue, and larvae can sometimes be found in sputum - Abdominal x-ray may show a nonspecific whirlpool or railway-track pattern; ultrasound and CT can spot worms in the biliary tree; ERCP both confirms and can remove biliary worms - WHO groups are also exploring a urine-based point-of-care antigen test, though its role in routine diagnosis is still under investigation IF NOT THIS - what else fits (11) - Acute cholangitis causes fever, right-upper-quadrant pain, and jaundice (Charcot triad); ascariasis instead shows linear, motile filling defects in the bile ducts rather than stones - Biliary colic from gallstones shows stones and a thickened gallbladder wall on ultrasound, whereas ascariasis shows mobile echogenic tubular structures without acoustic shadowing - Pancreatitis is usually from gallstones or alcohol, but ductal obstruction without stones on imaging should raise suspicion for worm migration into the pancreatic duct - Appendicitis can be mimicked by localized worm-related inflammation or obstruction, but imaging or seeing worms passed helps tell them apart - Small bowel obstruction from worm boluses is told apart from adhesions or hernia by imaging showing intraluminal filling defects or a whirlpool pattern - Large bowel obstruction is more often from tumor, volvulus, or stricture - ascariasis-related obstruction is usually in the small intestine instead - Intussusception in young children can have ascariasis as the lead point in endemic regions - Unlike asthma, the wheeze and dyspnea of the larval migratory phase are transient and come with eosinophilia and possible fever or infiltrates - Exposure history and peripheral eosinophilia help separate Loffler syndrome from asthma, pneumonia, and hypersensitivity pneumonitis - Hookworm also causes abdominal symptoms and eosinophilia but is linked more to iron-deficiency anemia than to obstruction or biliary disease - Other soil-transmitted worms like whipworm more often cause long-standing loose stools or rectal prolapse instead of blockage or bile-duct problems Source disease-level clinical article (intestinal-helminths-full.txt) Status traced to the source above 1. MEBENDAZOLE [1st line] Adult 500 mg single dose (WHO mass chemotherapy) or 100 mg twice daily for 3 days (clinical treatment of specific helminths) x 3 days Peds Over 1 year: 500 mg single dose OR 100 mg twice daily for 3 days (same as adult dose) (Same as adult dose for children over 1 year: 500 mg single dose or 100 mg twice daily for 3 days) Source Egyptian National Drug Formulary - Antimicrobial 2023 (mebendazole monograph): "Dosing: Adult, Adolescents and children > 2 years ... Oral: 100 mg twice daily for 3 days or 500 mg as a single dose". The formulary treats from 2 years; the from-12-months age floor shown here is WHO Human Helminthiasis 2017, which is not held in this corpus. The DailyMed mebendazole record is a bulk drug-substance listing with no posology. Why Benzimidazole anthelmintic that blocks glucose uptake in the parasite by disrupting its microtubules, starving and killing intestinal worms. Standard first-line agent for pinworm and other common intestinal helminths. Caution Contraindicated in 1st trimester of pregnancy. For pinworm, treat all household members and repeat in 14 days. Chew or crush tablets for young children. Egypt MEBAMOX 100MG 6 TAB. EL NASR 3.25 EGP (0.54/unit) PENTALMIN 100MG 6 TAB. PHAROPHARMA 3.50 EGP (0.58/unit) VERMIN 100MG 6 TAB. MEMPHIS 8.00 EGP (1.33/unit) ANTIVER 100MG 20*6 TABS. ALEXANDRIA 200.00 EGP (33.33/unit) ANTHELMIN 100MG/5ML SUSP. 30ML PHARCO 3.50 EGP -> ? strength differs, ? different route - not oral solid PERMAX 100MG/5ML SUSP. 30ML EIPICO 10.00 EGP -> ? strength differs, ? different route - not oral solid 2. ALBENDAZOLE [1st line] Adult 400 mg single dose with fatty meal (or 400 mg daily for 3 days) - single-dose Peds 1 to 2 years: 200 mg as a single dose Over 2 years: 400 mg as a single dose (400 mg single dose over 2 years, 200 mg for 1-2 years) Choice Alternatives. Albendazole 400 mg as a single dose is the WHO-preferred treatment for soil-transmitted helminths and covers a broader range than mebendazole. Source WHO Human Helminthiasis 2017 Why Benzimidazole anthelmintic with the same microtubule-disrupting, glucose-starving mechanism as mebendazole, and a broader spectrum against intestinal worms; a WHO- recommended alternative first-line option. Caution Contraindicated in pregnancy - verify non-pregnant status. Take with fatty food to enhance absorption. Abdominal pain and diarrhea may occur during worm expulsion. Egypt ALBENDAZOLE 400 MG 6 TABS PHARMA CURE P... 46.00 EGP (7.67/unit) ANTIZOLE 100MG/5ML SUSP. 30ML ALEXANDRIA 19.00 EGP -> ? strength differs, ? different route - not oral solid ALZENTAL 20MG/ML SUSP. 20ML EIPICO 21.00 EGP -> ? strength differs, ? different route - not oral solid 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Ascariasis - StatPearls disease-level clinical article, filed as intestinal-helminths- clinical.txt Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Complete intestinal obstruction, volvulus, ischemia, or perforation requires urgent surgical or endoscopic intervention. 4. IVERMECTIN [2nd line] Adult 200 mcg/kg single dose - single-dose Peds 0.2 mg/kg/dose [child max 15 mg] (Single dose (200 mcg/kg) for children >= 15 kg; take with water on an empty stomach) Not for children under 15 kg 15kg -> 3 mg/dose 16kg -> 3.2 mg/dose 17kg -> 3.4 mg/dose 18kg -> 3.6 mg/dose 19kg -> 3.8 mg/dose 20kg -> 4 mg/dose 21kg -> 4.2 mg/dose 22kg -> 4.4 mg/dose 23kg -> 4.6 mg/dose 24kg -> 4.8 mg/dose 25kg -> 5 mg/dose 26kg -> 5.2 mg/dose 27kg -> 5.4 mg/dose 28kg -> 5.6 mg/dose 29kg -> 5.8 mg/dose 30kg -> 6 mg/dose 31kg -> 6.2 mg/dose 32kg -> 6.4 mg/dose 33kg -> 6.6 mg/dose 34kg -> 6.8 mg/dose 35kg -> 7 mg/dose 36kg -> 7.2 mg/dose 37kg -> 7.4 mg/dose 38kg -> 7.6 mg/dose 39kg -> 7.8 mg/dose 40kg -> 8 mg/dose 41kg -> 8.2 mg/dose 42kg -> 8.4 mg/dose 43kg -> 8.6 mg/dose 44kg -> 8.8 mg/dose 45kg -> 9 mg/dose 46kg -> 9.2 mg/dose 47kg -> 9.4 mg/dose 48kg -> 9.6 mg/dose 49kg -> 9.8 mg/dose 50kg -> 10 mg/dose Source Egyptian National Drug Formulary - Antimicrobial 2023 (ivermectin monograph) Why Binds glutamate-gated chloride channels in the parasite's nerve and muscle cells, causing paralysis and death. Used as the alternative agent when Strongyloides or Ascaris is suspected, as noted in the cautions, rather than as routine first-line therapy. Caution The Egyptian National Drug Formulary - Antimicrobial 2023 ivermectin monograph does not contraindicate it by age. What it says is to avoid the drug below 2 years or 15 kg, or to use it there only with extreme caution and close monitoring, because the blood-brain barrier is less developed at that age than in an older child and the risk of CNS effects - encephalopathy - is higher. Its dosing section starts at children 15 kg and over. Take on an empty stomach with water. Ivermectin is an alternative agent for Strongyloides and Ascaris infections. Egypt IVACTIN 6MG 6 F.C.TABS. DELTA PHARMA 13.50 EGP (2.25/unit) IVERZINE 6MG 24 TABS. UNIPHARMA CO.... 84.00 EGP (3.50/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)