Threadworms - Treatment 

To successfully treat threadworms, the entire household must be treated, even if not everyone has symptoms.

The aim of treatment is to get rid of the threadworms and prevent re-infection.

You can do either of the following:

• follow a strict hygiene method (see below) for six weeks
• take medication and follow a strict hygiene method for two weeks

Some medications may be available from your pharmacy without prescription. Always follow the manufacturer’s instructions because these types of medications may not be suitable for everyone. See your GP if you have threadworms and:

• you are pregnant
• you are breastfeeding
• you have a baby under three months old

Hygiene method

Strict hygiene measures can be used to clear up a threadworm infection and reduce the likelihood of re-infection. As the life span of the threadworms is approximately six weeks, it is important that these hygiene methods are followed for six weeks. Everyone in the household must follow this advice.

• Wash all sleepwear, bed linen, towels and cuddly toys when you are first diagnosed (this can be done at normal temperatures but make sure that the washing is well rinsed).
• Thoroughly vacuum and dust the whole house, paying particular attention to the bedrooms. Continue to vacuum regularly and thoroughly. 
• Carefully clean the bathroom and kitchen by damp-dusting surfaces and washing the cloth frequently in hot water. Continue to clean bathroom and kitchen surfaces regularly and thoroughly. 
• Avoid shaking any material that may have eggs on it, such as clothing or bed sheets, as this may transfer the eggs to other surfaces.
• Do not eat food in the bedroom because you may end up swallowing eggs that have been shaken off the bedclothes.
• Keep your fingernails short.
• Discourage nail biting and finger sucking. In particular, make sure that children do not suck their thumb.
• Wash your hands frequently and scrub under your fingernails, particularly before eating, after going to the toilet and before and after changing a nappy.
• Wear close-fitting underwear at night and change your underwear every morning.
• Wearing cotton gloves at night may help prevent scratching while you are asleep.
• Bath or shower regularly, particularly first thing in the morning, and make sure you clean around your anus and vagina to remove any eggs. 
• Ensure that everyone in your household has their own face flannel and towel. Avoid sharing towels.
• Keep toothbrushes in a closed cupboard and rinse them thoroughly before use.

Even after the infestation has cleared up, continue with good general hygiene measures, such as washing your hands after going to the toilet. Children can easily pick up another threadworm infection from friends or at school, and good hygiene may help prevent another outbreak.

Medication

Medication can be used to treat threadworms. It should be taken by everyone in the household. The high risk of transmission (around 75% between family members) means that everyone is likely to be infected, even if they do not have any symptoms.

See the information below if you are pregnant, breastfeeding or you have a baby under three months old.

The most common medications that are used to treat threadworm infections are:

• mebendazole
• piperazine

Mebendazole

Mebendazole prevents the threadworms from being able to absorb glucose, which means they will die within a few days.

Mebendazole is the preferred treatment option for children over two years of age. It can be bought over-the-counter or prescribed by your GP, and is available as a chewable tablet or in liquid form.

As re-infection is very common, a second dose of mebendazole may be prescribed to be taken after two weeks. Follow the dosage information that is provided on the label or in the patient information leaflet that comes with the medicine.  
 
In rare cases, mebendazole can cause abdominal pain or diarrhoea, particularly if the infection of threadworms is severe.

Piperazine

Piperazine paralyses the threadworms until they are pushed naturally out of the bowel. It is combined with a medication called senna, which has a laxative effect (helps you empty your bowels) to expel the worms quicker. Piperazine and senna usually come in a sachet of powder, which you mix with a small amount of milk or water before drinking.

Piperazine can be used to treat children who are between three months and two years of age. As re-infection is very common, a second dose may be taken after two weeks. As with mebendazole, dosage information will be provided on the label or in the patient information leaflet that comes with the medicine.

Piperazine is not recommended if you have epilepsy (a condition that causes seizures) or problems with your liver or kidneys.

Mebendazole and piperazine are 90-100% effective at killing the threadworms, but they cannot kill the eggs. Strict hygiene measures should still be followed for two weeks after treatment (see above).

See your GP if the infection continues after using medication. They may recommend that you begin a second course of medication.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, the hygiene method is preferred for treating a threadworm infection. Medication for threadworm is not usually recommended.

See your GP if you are more than three months pregnant or if you are breastfeeding, and you have problems treating the threadworm infection using only the hygiene method. In certain circumstances, your GP may consider prescribing medication.

Babies under three months of age

Medication is not advised for babies under three months of age. Instead, follow the hygiene method. Make sure that you wash the baby’s bottom gently but thoroughly every time you change their nappy. Also wash your hands before and after changing their nappy.