Reducing worm infections in children
Many children are likely to be infected with intestinal worms or helminths (caused by parasites) such as roundworms, hookworms from the time they are no longer breast-fed, and they can be continually infected and re-infected for the rest of their lives. School-age children have the highest intensity of worm infections; therefore, parents need to be extra cautious about treating worm infections.
How do they get infected?
For hookworms, they are usually transmitted via soil contaminated with worm larvae penetration into human skin. In some worm infections, it is also transmitted by the oral route. When the larvae reach the small intestine, the eggs reside and mature into adult worms.
Therefore, it is advisable that parents ensure the environment around the child is clean and sanitary, with proper hand washing techniques practised by everyone in the family. It is also advisable for children to wear shoes/ slippers whenever they go outdoors to walk to reduce transmission.
Symptoms of infection include
-stomach problems such as diarrhoea and abdominal pain,
-general tiredness and weakness,
– lowered immunity,
– impairment of nutrient intake, digestion and absorption,
-stunted growth, delayed learning and development,
-intestinal blockages which may require surgery and chronic intestinal blood loss that results in loss of iron anaemia (caused by hookworms).
Deworming treatment
The mainstay medication used in Malaysia belong to the Benzimidazole drug class which include Mebendazole and Albendazole. They act by binding to free beta-tubulin and inhibit the tubulin and microtubule dependent glucose uptake inside the worms, hence killing them.
| Treatment options | Relevant Information |
| a) Albendazole
-Available as 200 mg tablets and Oral suspension 200 mg/5 mL (10 mL packaging)
|
Indications/Uses:
Infestations of all common worms eg, roundworm, whipworm, hookworm, pinworm, threadworm & tapeworm.
Dosage/Direction for Use: Adult & children >2 yr Roundworm, whipworm, hookworm & pinworm 400 mg as a single dose. Threadworm & tapeworm 400 mg as a single dose for 3 consecutive days.
Children 12mth to 24 mth: 200mg as a single dose. Not indicated for children below 12 months
Administration: Should be taken with food to increase absorption.
Side Effects / Adverse Reactions: Gastrointestinal discomfort, dizziness, headache |
| b) Mebendazole
-Available as chewable 500mg tablet |
Indications / Uses:
Infections with 1 or several of the following worms: Pinworm, whipworm, roundworm, hookworm, threadworm & tapeworm.
Dosage / Direction for Use: Adult & children >2 yr 1 tab or 10 mL as a single dose. Re-infestation May repeat the single dose 3-4 times annually. Not indicated for children below 2 years of age.
Administration: May be taken with or without food.
Side Effects / Adverse Reactions: Gatrointestinal disturbances. |
Preventive chemotherapy (deworming) in living areas where the baseline prevalence of any soil-transmitted infection is 20% or more among children
The World Health Organisation (WHO) recommends
Using annual or bi-annual* (twice a year) single-dose albendazole (400 mg) or mebendazole (500 mg) ** for all young children 12-23 months of age, preschool children 1–4 years of age, and school-age children 5-12 years of age (in some settings up to 14 years of age) living
* Biannual administration is recommended where the baseline prevalence is more than 50%.
** A half-dose of albendazole (200 mg) is recommended for children below 24 months of age.
As the medication is safe, widescale public health intervention programme that are conducted at poorer living areas usually administer the deworming medication to uninfected children as well.
References:
Uptodate 2018
World Health Organization (WHO), http://www.who.int/elena/titles/deworming/en/
World Vision International, https://www.wvi.org/health/intervention-11-de-worming
MIMS 2018
Ms Tan Li yin is a Malaysian currently working as a pharmacist in Sengkang GH Singapore.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]