Q: I babysat my grandchildren at their house on the weekend and one of them now has pinworms. Can I just go to the pharmacy to pick up medication for this or do I need a prescription?
Yes. There are two commonly used medications for pinworms, and your pharmacist can help determine whether treatment is appropriate. Combantrin, which contains pyrantel pamoate, is available without a prescription but is kept behind the counter, so a consultation with the pharmacist is required for purchase. Vermox, which contains mebendazole, requires a prescription; however, pharmacists in New Brunswick are authorized to assess and prescribe treatment for pinworms.
Unlike some other minor ailments treated by pharmacists, pinworm and threadworm assessments are not currently publicly funded by the provincial government. A pharmacy service fee applies for the assessment, although some private insurance plans may reimburse the cost.
Pinworms are small, thin, parasitic worms that live in the intestine. They are about the length of a staple and resemble small pieces of white thread. During the night, female worms travel to the area around the anus to lay their eggs, causing the characteristic symptom of pinworms: intense itching around the anus, particularly at night. Children may also experience restless sleep or irritability, while some people have no symptoms at all.
Pinworms spread very easily from person to person. When someone scratches the itchy area, microscopic eggs can collect on their fingers and underneath their fingernails. The eggs can then be transferred to bedding, towels, clothing, toys, bathroom surfaces and other objects. Infection occurs when the eggs eventually make their way into someone’s mouth, often from contaminated hands.
Simply spending time in a home where someone has pinworms doesn’t automatically mean you need medication. Treatment is generally recommended for the infected person and household members because transmission within a household is common. Other contacts are assessed based on how much close contact they have had with the infected person and whether they have symptoms. Your pharmacist can help determine whether treatment is necessary based on your particular exposure.
When treatment is needed, Combantrin and Vermox are both effective options. Combantrin is dosed according to weight, while Vermox is generally given as a 100mg dose. When used appropriately, both medications are highly effective against pinworms.
One of the most important parts of treatment is remembering the repeat dose. The medications kill the worms but do not reliably eliminate all of the eggs. For this reason, a second dose is taken 14 days later to kill worms that have hatched since the first dose. Reinfection is common, so if pinworms seem to keep coming back, it doesn’t necessarily mean the medication didn’t work.
Medication is only one part of getting rid of pinworms. Careful hygiene helps break the cycle of reinfection. Everyone in the household should wash their hands thoroughly with soap and water after using the bathroom or changing diapers and before preparing or eating food. Keep fingernails short and discourage nail biting, thumb sucking and scratching around the anus. Showering or bathing in the morning can help remove eggs deposited on the skin overnight, and underwear should be changed daily.
Bedding, towels, pyjamas and clothing used by the infected person should be washed regularly in hot water and dried thoroughly. Avoid shaking bedding or clothing before washing it, since this can spread eggs into the environment. Frequently touched bathroom and household surfaces should also be cleaned. Pinworm eggs can survive outside the body for a couple of weeks, which is why hygiene remains important even after everyone has taken their first dose of medication.
If you suspect pinworms, you may be able to see tiny white, thread-like worms around the anus at night or first thing in the morning, or occasionally in underwear or bowel movements. Pinworm eggs are microscopic and cannot be seen with the naked eye, but they can sometimes be detected using the “Scotch tape test”. This involves pressing a piece of clear adhesive tape against the skin around the anus first thing in the morning, before bathing or using the bathroom. Speak with your pharmacist if you suspect an infection. They can assess your symptoms and exposure, determine who should be treated and recommend Combantrin or prescribe Vermox when appropriate. Children under the age of two, people who are pregnant, have severe symptoms, or still have symptoms less than two weeks since after completing treatment should see a physician or nurse practitioner for assessment.