the pinworm adults, causing glycogen depletion, thereby effectively starving the parasite. a single 100 milligram dose of mebendazole with one repetition after two weeks, is considered the safest, and is usually effective with cure rate of 96%. mebendazole has no serious side effects, although abdominal pain and diarrhea have been reported. pyrantel pamoate (also called pyrantel embonate, brand names e.g., reese's pinworm medicine, pin-x, combantrin, anthel, helmintox, and helmex) kills adult pinworms through neuromuscular blockade, and is considered as effective as the benzimidazole compounds and is used as a second-line medication. pyrantel pamoate is available over the counter and does not require a prescription. pinworms located in the genitourinary system (in this case, female genital area) may require other drug treatments. treatment in pregnancy and breastfeeding the available data on mebendazole, albendazole, and pyrantel pamoate use in pregnancy is limited and they are all assigned to pregnancy category level c. treatment of a pinworm infection during pregnancy is only recommended for patients with significant symptoms that may be causing adverse effects to the pregnant woman such as loss of sleep and weight loss. pyrantel pamoate is the treatment of choice in pregnancy but should be used only after consultation with a health care practitioner rather than self-treatment. treatment should be avoided in the first trimester, and if possible done in the third trimester. if the pregnant woman is asymptomatic, then they should be treated after the baby is delivered. mebendazole has less than 10% of the oral dose absorbed into systemic circulation with a clinically insignificant amount of drug excreted in breastmilk, and therefore treatment should not be withheld during breastfeeding. there is limited data on the use of pyrantel pamoate and albendazole in breastfeeding but who also classifies them as compatible with breastfeeding. this is due to the drugs acting mainly in the intestinal system of the mother with only a very small amount of drug being absorbed into the systemic circulation. epidemiology pinworm infection occurs worldwide, and is the most common helminth (i.e., parasitic worm) infection in the united states and western europe. in the united states, a study by the center of disease control reported an overall incidence rate of 11.4% among people of all ages. pinworms are particularly common in children with approximately 30% of children being infected and most commonly seen in children between 7 and 11 years old. the prevalence rates in children having been reported as high as 61% in india, 50% in england, 39% in thailand, 37% in sweden, and 29% in denmark. finger sucking has been shown to increase both incidence and relapse rates, and nail biting has been similarly associated. because it spreads from host to host through contamination, enterobiasis is common among people living in close contact, and tends to occur in all people within a household. the prevalence of pinworms is not associated with gender, nor with any particular social class, race, or culture. pinworms are an exception to the tenet that intestinal parasites are uncommon in affluent communities. history the earliest known instance of pinworms is evidenced by pinworm eggs found in coprolite, carbon dated to 7837 bc at western utah. pinworm infection is not classified as a neglected tropical disease unlike many other parasitic worm infections. garlic has been used as a treatment in the ancient cultures of china, india, egypt, and greece. hippocrates (459–370 bc) mentioned garlic as a remedy against intestinal parasites. german botanist lonicerus (1564) recommended garlic against parasitic worms. notes "pinworm infection faqs". cdc. 10 january 2013. archived from the original on 15 october 2016. retrieved 16 october 2016. "epidemiology & risk factors". cdc. 10 january 2013. archived from the original on 18 october 2016. retrieved 16 october 2016. stermer, e; sukhotnic, i; shaoul, r (may 2009). "pruritus ani: an approach to an itching condition". journal of pediatric gastroenterology and nutrition. 48 (5): 513–6. doi:10.1097/mpg.0b013e31818080c0. pmid 19412003. "treatment". cdc. 23 september 2016. archived from the original on 18 october 2016. retrieved 16 october 2016. griffiths, christopher; barker, jonathan; bleiker, tanya; chalmers, robert; creamer, daniel (2016). rook's textbook of dermatology, 4 volume set (9 ed.). john wiley & sons. p. 33.13. isbn 9781118441176. archived from the original on 5 november 2017. "biology". cdc. 10 january 2013. archived from the original on 18 october 2016. retrieved 16 october 2016. bynum, w. f.; porter, roy (2013). companion encyclopedia of the history of medicine. routledge. p. 358. isbn 9781136110368. archived from the original on 5 november 2017. burkhart & burkhart 2005, p. 838 cook et al. 2009, p. 1516 gutiérrez 2005, p. 355. caldwell 1982, p. 307. cook 1994, p. 1159 russell, l. j. (1991). "the pinworm, enterobius vermicularis". primary care. 18 (1): 13–24. doi:10.1016/s0095-4543(21)00913-1. issn 0095-4543. pmid 2011634. cook 1994, p. 1160 gutiérrez 2005, p. 356. gutiérrez 2005, p. 363. gutiérrez 2005, p. 354. burkhart & burkhart 2005, p. 837 garcia 1999, p. 246 cook, g c (1994). "enterobius vermicularis infection". gut. 35 (9): 1159–1162. doi:10.1136/gut.35.9.1159. issn 0017-5749. pmc 1375686. pmid 7959218. caldwell 1982, p. 308. canada, health (17 may 1996). "anthelmintics". www.canada.ca. retrieved 23 november 2021. prevention, cdc-centers for disease control and (19 april 2019). "cdc - enterobiasis - diagnosis". www.cdc.gov. retrieved 23 november 2021. dpdx 2009 garcia 1999, p. 247 cook 1994, p. 1161 caldwell 1982, p. 309. prevention, cdc-centers for disease control and (18 december 2020). "cdc - enterobiasis - prevention & control". www.cdc.gov. retrieved 23 november 2021. "threadworms". nhs.uk. 8 january 2018. retrieved 23 november 2021. rawla, prashanth; sharma, sandeep (2021), "enterobius vermicularis", statpearls, treasure island (fl): statpearls publishing, pmid 30725659, retrieved 30 november 2021 prevention, cdc-centers for disease control and (26 august 2019). "cdc - enterobiasis - resources for health professionals". www.cdc.gov. retrieved 30 november 2021. cook, g. c. (1994). "enterobius vermicularis infection". gut. 35 (9): 1159–1162. doi:10.1136/gut.35.9.1159. issn 0017-5749. pmc 1375686. pmid 7959218. world health organization (2002). "breastfeeding and maternal medication : recommendations for drugs in the eleventh who model list of essential drugs". hdl:10665/62435. : cite journal requires |journal= (help) dezsényi, balázs; sárközi, lászló; kaiser, lászló; tárkányi, klára; nikolova, radka; belics, zorán (1 december 2018). "gynecological and obstetrical aspects of enterobius vermicularis infection". acta microbiologica et immunologica hungarica. 65 (4): 459–465. doi:10.1556/030.65.2018.020. issn 1217-8950. pmid 29552897. s2cid 3981456. "fact sheets: neglected tropical diseases". world health organization. who media centre. archived from the original on 7 december 2014. retrieved 6 december 2014. petrovska bb, cekovska s (2010). "extracts from the history and medical properties of garlic". pharmacognosy reviews. 4 (7): 106–10. doi:10.4103/0973-7847.65321. pmc 3249897. pmid 22228949. tucakov j. beograd: naucna knjiga; 1948. farmakognozija; pp. 278–80. 3. tucakov j. beograd: kultura; 1971. lecenje biljem - fitoterapija; pp. 180–90.