What are the recommended first-line treatments for Enterobius vermicularis infection in children?

For children over 6 months of age, the recommended first-line treatment for Enterobius vermicularis (threadworm) infection is a single dose of an anthelmintic such as mebendazole ¹. If the infection persists, the dose may need to be repeated after 2 weeks ¹.

For children under the age of 6 months, treatment should consist of hygiene measures alone for 6 weeks ¹. Mebendazole is not licensed for use in children under 2 years of age ¹. For children under 2 years, it is recommended to consult with an infectious disease specialist before administering anthelmintics, as these drugs have not been extensively studied in this age group ¹.

It is also recommended to consider treating all household contacts, unless contraindicated, due to the high transmissibility of threadworms ¹.

Rigorous hygiene measures are crucial alongside medication or as the sole treatment. These measures should be followed for 2 weeks if treated with mebendazole, or for 6 weeks if using hygiene measures alone ¹. Key hygiene practices include: thorough hand washing with soap and warm water after using the toilet, changing nappies, and before handling food; regular nail cutting and avoiding nail biting or scratching around the anus; showering each morning, including the perianal area, to remove eggs; and changing bed linen and nightwear daily for several days after treatment, washing them on a hot cycle ¹. Thorough dusting and vacuuming (including mattresses) and damp-dusting bathroom surfaces are also advised ¹.