How to treat an 8-month-old child with Enterobius vermicularis, when Vanquin (pyrvin) is not availa

Fråga: How to treat an 8-month-old child with Enterobius vermicularis, when Vanquin (pyrvin) is not available?

Sammanfattning: Mebendazole is the only alternative for the treatment of Enterobius vermicularis when pyrvin is not available. However, seizures in children under one year of age caused by mebendazole have been observed. In the treatment of Ascaris lumbricoides in children under one year of age, half of the dose for adults has been recommended. The indication for treatment of Enterobius vermicularis, a relatively mild disease, should be balanced against the risk for side-effects.

Svar: Drugs which are registered in Sweden for use in treatment of Enterobius vermicularis include Vanquin and Vermox (mebendazole). However, in FASS it is stated that experience of mebendazole usage in children younger than two years of age is limited. As a result of a few cases of seizures reported in children under one year of age, mebendazole is not recommended in children unless the infections significantly affect the nutrition status and physical development of the children (1).

A question concerning mebendazole treatment for Ascaris lumbricoides in children under two years of age has been documented in Drugline (2). In summary, the recommendation that mebendazole should not be used in children under two years of age is not based on controlled clinical studies. In practice the drug is nevertheless used in small children (< two years) since there is no proper alternative treatment for Ascaris lumbricoides. Half of the adult dose has been recommended for children under one year of age (2). However, the indication of drug treatment for Ascaris lumbricoides is stronger than for Enterobius vermicularis.

An updated Medline search did not provide more information. The manufacturer of mebendazole is aware of some cases of seizures in small children (3).

At Huddinge Hospital, mebendazole has been used in children as young as one year of age and no cases of seizure have been observed. However, experience in children under one year of age is lacking. In difficult situations the child can be referred to specialists at Huddinge Hospital (4).

Niclosamide (Yomesan) is a drug registered for the treatment of most human intestinal cestode infections. It has been stated that Enterobius vermicularis is also susceptible to this drug (5). However, clinical studies and dose recommendations are lacking. 1 FASS

2 Drugline nr 08691 (year 1991) (enclosed)
3 Personal communication Magnus Larsson, Janssen
4 Personal communication Dr Lars Rombo, Department of Infectious Diseases, Huddinge Hospital

5 Goodman and Gilman, The pharmacological basis of therapeutics. 1990; 8th ed: 965-6