Ascariasis is a parasitic infectious disease caused by roundworms (nematodes), Ascaris lumbricoides, which generally attacks the small intestine in individuals living in tropical and subtropical areas.

Ascariasis is the most common nematode infection in the world. According to statistics, Ascaris lumbricoides infected around 1.2-1.5 billion people living in tropical and subtropical areas.

This infection generally occurs when children do not wash their hands after playing in contact with worm-contaminated soil and then touch their mouth, intentionally or not. Also, ascariasis can be caused by eating vegetables and fruits contaminated with worms and not washed clean.

Ascaris Worm Exiting through Child's Anal
Ascaris Worm Exiting through Child's Anal
Image source: Parasitology Atlas

Medical Treatment of Intestinal Ascariasis in Children

What are antihelmintic drugs for treating ascariasis in children?

There are various antihelminthic drugs on the market, such as albendazole, mebendazole, pyrantel pamoate,  and ivermectin). However, the safety of using them in children is still not fully understood.

Based on the 2018 Center for Disease Control and Prevention, the drugs of choice for intestinal ascariasis are albendazole, mebendazole, and oral ivermectin, where the child's dose is the same as the adult.

According to the World Health Organization recommendations, medical treatment for ascariasis using albendazole, levamisole, mebendazole, and pyrantel pamoate are considered effective with a cure ratio of> 90%.

Antihelmintic agents of choice in the United States so far are albendazole, mebendazole, and pyrantel pamoate, with 95%, 88%, and 88% effectiveness and respectively.

The management regimen used for ascariasis has been proven effective in eradicating Ascaris lumbricoides. However, existing research on safety for children aged <6 years, especially the toddler age group, is still very limited.

a. Albendazole

The use of albendazole in the treatment of ascariasis in children is a single dose of 400 mg, taken after meals. This drug's mechanism is to reduce energy production (ATP) in worms, thus causing immobilization and death.

A clinical trial has shown that albendazole is effective as an antihelmintic agent against Ascaris lumbricoides. However, safety for children <6 years old is still unclear. WHO does not recommend giving this drug regularly to children with ascariasis who are under two years old.

However, albendazole is the drug of choice in this age group to treat community ascariasis targeting high-risk populations. Most cases of helminthiasis in children <6 years old are treated with albendazole, even though clinical practitioners often reduce the dose.

b. Mebendazole

Mebendazole dose is 2 x 100 mg/day for three days or 500 mg single dose, can be swallowed immediately, chewed, crushed first, or mixed with food. This drug's mechanism is to selectively inhibit the irreversible uptake of glucose in the intestine that is occupied by worms, causing worm immobilization and death.

Safety for children aged under two years is still unclear, and WHO guidelines state that its use in children aged tahun1 years is not recommended and must assess the risks and benefits that exist. Even, mebendazole is still one of the antihelmintic agents that can be used for children up to age 12 years, according to WHO.

c. Pyrantel Pamoate

The administration of Pyrantel pamoate is at a dose of 11mg / kg weight single dose, a maximum of 1g / dose. This drug works by inhibiting neuromuscular delivery and cholinesterase, causing spastic paralysis of the worms. So, the worms can be removed through feces. Safety for children <2 years old is still unclear.

d. Ivermectin

This drug can be given in a dose of 50-200 mcg/kg weight single dose, taken on an empty stomach. This drug works by binding selectively with chloride channels in nerve cells and worm muscles, causing death.

The safety of ivermectin for children <15kg is unclear. According to WHO, safe ivermectin for children with height ≥90cm (or the equivalent age of 30 months for females and 28 months for males). According to the CDC, this drug has been widely used in mass medicine for children aged three years and over with reduced doses.


Conclusion
In the case of ascariasis, the treatment regimen for children aged <6 years is the same as for adults. These drugs have been proven effective for the management of ascariasis. Even so, some of these regimens in children's safety are still unknown, but until now, these drugs are still used and recommended by the CDC and WHO.

Various drug options that can be used for intestinal ascariasis in children <6 years old are:
  • Pirantel pamoat 11 mg / weight single dose, maximum 1 g / dose
  • Albendazole 400mg single dose
  • Mebendazole 2 x 100 mg / day for 3 days or 500 mg single dose