Treatment of trichuris infection with albendazole

Abstract

Intestinal helminth infections cause deficits in growth, nutrition, and cognitive function,1Savioli L Bundy D Tomkins A Intestinal parasitic infections: a soluble public health problem.Trans R Soc Trop Med Hyg. 1992; 86: 353-354Summary Full Text PDF PubMed Scopus (162) Google Scholar, 2Stephenson LS Latham MC Kurz KM Kinoti SN Brigham H Treatment with a single dose of albendazole improves growth of Kenyan schoolchildren with hookworm, Trichuris trichiura, and Ascaris lumbricoides infections.Am J Trop Med Hyg. 1989; 41: 78-87PubMed Google Scholar which recently led the World Bank to rank these infections as the main cause of morbidity in school-aged children throughout the developing world.3World BankWorld development report 1993: investing in health. Oxford University Press, New York1993Crossref Google Scholar Consistent with these findings, J E Forrester and colleagues4Forrester JE Bailar III, JC Esrey SA Jose MV Castillejos BT Ocampo G Randomised trial of albendazole and pyrantel in symptomless trichuriasis in children.Lancet. 1998; 352: 1103-1108Summary Full Text Full Text PDF PubMed Scopus (35) Google Scholar report improved growth after deworming of children with high-intensity Trichuris trichiura infections. However, they also report that among children with the lowest levels of infection (10–510 eggs per g of stool), those who received either standard (400 mg) or high-dose (1200 mg) albendazole had reduced growth compared with the children on pyrantel. The study did not include a placebo arm for comparison, and the slight reductions in growth were attributed to treatment with albendazole. These workers extrapolated these findings to suggest that uninfected children who are included in mass treatment programmes may also have reduced growth after treatment with albendazole. We have examined growth of Haitian schoolchildren after treatment with albendazole, ivermectin, combined albendazole and ivermectin, or placebo.5Beach MJ Streit TG Addiss DG Prospere R Roberts JM Lammie PJ, Assessment of combined ivermectin and albendazole for treatment of intestinal helminth and Wuchereria bancrofti infections in Haitian schoolchildren. Am J Trop Med Hyg (in press).Google Scholar In this study, simultaneous administration of both albendazole and ivermectin was more efficacious against trichuris infection than either drug alone, and among trichuris-infected children, combined drug treatment resulted in significantly greater weight gain than was seen in children who received placebo. Of 158 children infected only with trichuris in the four treatment arms of our study, 148 (94%) had infection intensities that fell in the lowest levels defined by Forrester et al. In view of Forrester and colleagues' report, we reanalysed our data for children included in these workers' definition of low-intensity trichuris infection (10–510 eggs per g of stool). By contrast with Forrester et al, we showed no significant differences in mean height or weight gain between the placebo and albendazole (400 mg) treatment arms for these children (table). Furthermore, because all children were treated en masse before stool test results were analysed, we were able to examine the effect of treatment in those children who proved uninfected by intestinal helminths. In uninfected children, no significant differences in mean weight or height gain were noted between the placebo and albendazole treatment arms (table). Comparsion of mean weight gain in the placebo arm of the trichuris-infected and uninfected children (table) suggests that low intensity trichuris infections may be associated with a reduction in mean weight gain, although this trend was not statistically significant (two-tailed t-test, p=0·24).TableWeight and height gain in uninfected children and those with low-intensity trichuris infection 4 months after treatmentMean weight gain (kg)Mean height gain (cm)PlaceboAlbendazolePlaceboAlbendazoleTrichuris only*No Ascaris lumbricoides, hookworm, or Wuchereria bancrofti infections, trichuris intensity ≤510 eggs per g of stool;0·71 (33)0·94 (38)1·96 (33)1·85 (38)Uninfected†no A lumbricoides, hookworm, T trichiura, or W bancrofti infections.0·93 (91)0·92 (95)1·82 (91)1·75 (95)Numbers of children shown in parentheses.* No Ascaris lumbricoides, hookworm, or Wuchereria bancrofti infections, trichuris intensity ≤510 eggs per g of stool;† no A lumbricoides, hookworm, T trichiura, or W bancrofti infections. Open table in a new tab Numbers of children shown in parentheses. We advise caution in interpreting data on intestinal helminth infection intensity in the absence of a placebo control group, because variability in stool egg density can be considerable. The finding of beneficial effects of deworming in children with symptomless, low-intensity infections5Beach MJ Streit TG Addiss DG Prospere R Roberts JM Lammie PJ, Assessment of combined ivermectin and albendazole for treatment of intestinal helminth and Wuchereria bancrofti infections in Haitian schoolchildren. Am J Trop Med Hyg (in press).Google Scholar shows that there are public health benefits to be gained from mass treatment of at-risk populations. Treatment of trichuris infection with albendazoleAuthors' reply Full-Text PDF