Abstract
BackgroundPreventive chemotherapy with albendazole or mebendazole is the current strategy to control soil-transmitted helminth (STH) infections (i.e. Ascaris lumbricoides, hookworm and Trichuris trichiura). STH reinfections, in particular A. lumbricoides and T. trichiura occur rapidly after treatment with the standard drugs. However, their low efficacy against T. trichiura, made an accurate assessment of reinfection patterns impossible.MethodsIn 2013 a randomised controlled trial was conducted on Pemba Island, Tanzania. School-aged children diagnosed positive for T. trichiura, were randomly allocated to (i) albendazole-ivermectin; (ii) albendazole-mebendazole; (iii) albendazole-oxantel pamoate; or (iv) mebendazole. Here we report the efficacy [cure rates (CR) and egg-reduction rates (ERR)], reinfection rates and new infections determined 18 weeks post-treatment.ResultsFor a total of 405 children complete baseline and follow-up data were available. Similar to the efficacy determined after 3 weeks, 18 weeks after treatment albendazole-oxantel pamoate showed a significantly higher efficacy against T. trichiura (CR: 54.0 %, 95 % CI: 43.7–64.0; ERR: 98.6 %, 95 % CI: 97.8–99.2) compared to the other treatment arms. Children treated with albendazole-oxantel pamoate or albendazole-ivermectin had fewer moderate infections compared to children treated with albendazole. The reinfection rates 18 weeks post-treatment among all treatment arms were 37.2 % for T. trichiura (95 % CI: 28.3–46.8), 34.6 % for A. lumbricoides (95 % CI: 27.3–42.3) and 25.0 % for hookworms (95 % CI: 15.5–36.6).ConclusionThe moderate reinfection rates with STHs 18 weeks post-treatment support the concept of regular anthelminthic treatment in highly endemic settings. Combination chemotherapy might achieve decreased morbidity in children since in the albendazole plus oxantel pamoate and albendazole plus ivermectin treatment arms only few moderate T. trichiura infections remained. Further trials should investigate the long term efficacy of albendazole-oxantel pamoate (i.e. 6 and 12 month post-treatment) and after several rounds of treatment in order to develop recommendations for appropriate control approaches for STH infections.Trial registrationCurrent Controlled Trials ISRCTN80245406Electronic supplementary materialThe online version of this article (doi:10.1186/s13071-016-1406-8) contains supplementary material, which is available to authorized users.
Highlights
Preventive chemotherapy with albendazole or mebendazole is the current strategy to control soiltransmitted helminth (STH) infections (i.e. Ascaris lumbricoides, hookworm and Trichuris trichiura)
At the second follow-up, the efficacy of the other treatment arms remained significantly lower compared to albendazole-oxantel pamoate in terms of cure rates (CR) (P-values in Table 1) and egg-reduction rates (ERR) (98.6, confidence intervals (CI): 97.8–99.2) compared to the other treatments at the second follow up
Considering the arithmetic ERRs, albendazole combined with ivermectin and albendazole-oxantel pamoate were significantly higher compared to the other treatments 18 weeks post-treatment (Additional file 1: Table S1)
Summary
Preventive chemotherapy with albendazole or mebendazole is the current strategy to control soiltransmitted helminth (STH) infections (i.e. Ascaris lumbricoides, hookworm and Trichuris trichiura). STH reinfections, in particular A. lumbricoides and T. trichiura occur rapidly after treatment with the standard drugs. Their low efficacy against T. trichiura, made an accurate assessment of reinfection patterns impossible. The most common soil-transmitted helminths (STH; Ascaris lumbricoides, hookworms and Trichuris trichiura) infect approximately 1.5 billion people [1] worldwide with the highest prevalences in Asia and Africa. The most common anthelminthic drugs are albendazole and mebendazole [5] Both drugs have high efficacy against A. lumbricoides, while only albendazole reveals a good performance in the treatment of hookworm infections. For the treatment of T. trichiura both drugs show poor cure rates in single-dose regimen [6]
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