otc

Question 1

What are Threadworms (pinworms) ?

Answer 1

• small white worms, 2-13mm long
• live in upper colon area
• only in humans, not transferrable to or from animals
• commonly affects children and residential homes

Question 2

How does Threadworms affect patients?

Answer 2

• intense itching and scratching due to large amount of eggs with irritant mucus
• Eggs are laid around anus or vaginal area
• Adult threadworms can live up to 6 weeks !

Question 3

How is diagnosis confirmed?

Answer 3

• sighting the worms , either around the perianal area, easily seen at night
• or more rarely on faeces

Question 4

secondary infection

Answer 4

• This can occur due to perianal scratching.

- In heavy infestation, this can lead to loss of appetite, weight loss, insomnia, irritability and enuresis

Question 5

perianal itching in adults

Answer 5

• may be due to haemorrhoids, eczema or irritants

- other worm infection could be possible e.g roundworm, if suspected then refer.

Question 6

Treatment options

Answer 6

1. Suggest hygiene measures alone when drug treatment isnt wanted or not recommended (e,g in pregnancy)
2. if all practical tips we discussed, are followed for 6 weeks, all the worms would have died.
3. If anthelmintics are used, ALL members of the family should be treated simultaneously

Question 7

OTC treatment options

Answer 7

1. Mebendazole 100mg (Ovex or vermox) is treatment of choice in adults and children over 2 years of age! ( children between 6months- 2 only given on RX)
2. Given as a single oral dose but often needs to be repeated after 2-3 weeks if re-infection occurs
3. The whole family should be treated as theres high risk of infection spreading ( including those without symptoms)
4. ovex comes as either chewable tablets or liquid
5. common side effect is abdominal pain

Question 8

Ovex mode of action

Answer 8

• Inhibits the uptake of glucose by worms causing them to immobilise and die
• transient abdominal pain or diarrhoea can sometimes occur , especially in people with heavy infestation

Question 9

Counselling points to the patient

Answer 9

1. Wear close fitting pyjama bottoms or pants to avoid shedding eggs
2. bathe/shower first thing in the morning, paying specific attention to anal area
3. Emphasis good hygiene i.e washing hands after going the loo and before eating/preparing food. Ctutting fingernails short
4. wash bedding and towels daily if possible as eggs can stay viable for up to 2 weeks

Question 10

When to refer to GP

Answer 10

1. if they are preganant or breastfeeding
2. if the child is under 2
3. moderate interaction with cimetidine ( it increases conc of mebendazole)

Question 11

What are head lice?

Answer 11

• grey/brown 1-3mm long pediculus capitis
• They survive by sucking blood from the scalp of their host
• female louse lays eggs near hair shaft on scalp.
• egg shell firmly attaches to hair and cannot get washed off easily
• eggs hatch in about 7 days

Question 12

Confirmed diagnosis

Answer 12

• only made by finding live lice

- more common in school children, those with siblings, long hair, and lower socio-economic group

Question 13

How are they spread?

Answer 13

• via close head to head contact, so advise family and friends to check for infestation
• itching is a common symptom but can take up to 3 months to show as it could be asymptomatic till then.

Question 14

Treatment

Answer 14

1. TWO applications of insecticide 7 days apatrt
2. Each is to be left in the hair for 12 hours before rising off and hair is examined 14 days after to determine cure
3. Treatment failure occurs when only ONE application is used or if insufficient product is applied
4. average head of hair needs around 50ml.

Question 15

Treatment

Answer 15

5. Alcoholic lotions are preferred but aqueous liquid formulations can be used where asthma, eczema or broken skin are present.
6. The lotion should be left to dry naturally ( advise patients not to use hair dryer as the lotions are flammable )
7. Advise to avoid swimming directly before and during the use of lotions as chlorine inactivates insecticides.
8. Wet combing with a plastic detection comb plus conditioner should be performed every FOUR days over atleast TWO weeks until no lice are seen on 3 consecutive sessions. It is time consuming but suitable option for pregnant/breastfeeding women or children under 2.

Question 16

lotions

Answer 16

1. Hedrin (4% dimeticone) works by physically covering the lice and disrupting their ability to manage water balance. Must be left on for 8 hours and treatment repeated after 7 days

Question 17

treatment failure

Answer 17

if treatments fails, a different insecticide should be used at least THREE weeks after the last application of insecticide.