Abstract
BackgroundThe control of soil-transmitted helminth (STH) infections currently relies on the large-scale administration of single-dose oral albendazole or mebendazole. However, these treatment regimens have limited efficacy against hookworm and Trichuris trichiura in terms of cure rates (CR), whereas fecal egg reduction rates (ERR) are generally high for all common STH species. We compared the efficacy of single-dose versus triple-dose treatment against hookworm and other STHs in a community-based randomized controlled trial in the People's Republic of China.Methodology/Principal findingsThe hookworm CR and fecal ERR were assessed in 314 individuals aged ≥5 years who submitted two stool samples before and 3–4 weeks after administration of single-dose oral albendazole (400 mg) or mebendazole (500 mg) or triple-dose albendazole (3×400 mg over 3 consecutive days) or mebendazole (3×500 mg over 3 consecutive days). Efficacy against T. trichiura, Ascaris lumbricoides, and Taenia spp. was also assessed.Albendazole cured significantly more hookworm infections than mebendazole in both treatment regimens (single dose: respective CRs 69% (95% confidence interval [CI]: 55–81%) and 29% (95% CI: 20–45%); triple dose: respective CRs 92% (95% CI: 81–98%) and 54% (95% CI: 46–71%)). ERRs followed the same pattern (single dose: 97% versus 84%; triple dose: 99.7% versus 96%). Triple-dose regimens outperformed single doses against T. trichiura; three doses of mebendazole – the most efficacious treatment tested – cured 71% (95% CI: 57–82%). Both single and triple doses of either drug were highly efficacious against A. lumbricoides (CR: 93–97%; ERR: all >99.9%). Triple dose regimens cured all Taenia spp. infections, whereas single dose applications cured only half of them.Conclusions/SignificanceSingle-dose oral albendazole is more efficacious against hookworm than mebendazole. To achieve high CRs against both hookworm and T. trichiura, triple-dose regimens are warranted.Trial Registration www.controlled-trials.com ISRCTN47375023
Highlights
Hundreds of millions of people are infected with the common soil-transmitted helminths (STHs), namely hookworms (Ancylostoma duodenale and Necator americanus), Ascaris lumbricoides and Trichuris trichiura, many by multiple species concurrently [1,2,3,4,5]
Efficacy Against Hookworm and Other STHs A single dose of albendazole cured 69% of the hookworm infections, while single-dose mebendazole only cured 31%, significantly less (Table 2 and table 3)
Triple doses of either drug were significantly more efficacious than single-dose regimens, but the difference between the two drugs persisted: triple-dose albendazole cured significantly more hookworm infections (92%, 95% confidence intervals (CIs): 81–98%) than tripledose mebendazole (58%, 95% CI: 46–71%)
Summary
Hundreds of millions of people are infected with the common soil-transmitted helminths (STHs), namely hookworms (Ancylostoma duodenale and Necator americanus), Ascaris lumbricoides and Trichuris trichiura, many by multiple species concurrently [1,2,3,4,5]. The current strategy for STH control in highly endemic areas focuses on morbidity control through large-scale administration of single-dose anthelminthics to at-risk populations, school-aged children [9,13,14]. The control of soil-transmitted helminth (STH) infections currently relies on the large-scale administration of single-dose oral albendazole or mebendazole. These treatment regimens have limited efficacy against hookworm and Trichuris trichiura in terms of cure rates (CR), whereas fecal egg reduction rates (ERR) are generally high for all common STH species. We compared the efficacy of single-dose versus triple-dose treatment against hookworm and other STHs in a community-based randomized controlled trial in the People’s Republic of China
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