Clinical Practices in the Diagnosis and Treatment of Enterobiasis: A Retrospective Analysis

Enterobius vermicularis is the most common nematode infection in the United States. Despite this prevalence, few studies have evaluated current clinical practices with regard to diagnosis and management. Price increases in anthelmintics in the United States add a component of cost-conscious care to treatment selection. We conducted a retrospective analysis of 200 patients in the Military Health System with an International Classification of Diseases code diagnosis of enterobiasis from 2011 to 2018. A clinical diagnosis was made in 70.0% of symptomatic patients. A pinworm paddle or cellophane adhesive was ordered in 12.7% of symptomatic cases, with a positivity rate of 41.2%. Diagnostic studies ineffective for the diagnosis of enterobiasis were ordered in 12.0% of symptomatic cases, with the most common being ova and parasite examinations of the stool (10.0%). The most common initial treatment of enterobiasis was albendazole (73.6%) followed by mebendazole (15.0%), pyrantel (10.9%), and ivermectin (0.5%). Empiric retreatment of patients after initial treatment and empiric treatment of household members were prescribed or recommended in 86.0% and 49.7% of cases, respectively. Counseling on decontamination measures to prevent reinfection was documented in 35.2% of cases. This study suggests that there are knowledge gaps in the optimal diagnostic approach to enterobiasis as well as the role of adjunctive measures to prevent a cycle of continuous reinfection, such as empiric retreatment, empiric treatment of household members, and counseling on decontamination measures. Additionally, the prominence of albendazole use relative to pyrantel pamoate represents an opportunity for cost-conscious care.