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Randomized Controlled Trial
. 2016 Mar 2:9:123.
doi: 10.1186/s13071-016-1406-8.

Efficacy and reinfection with soil-transmitted helminths 18-weeks post-treatment with albendazole-ivermectin, albendazole-mebendazole, albendazole-oxantel pamoate and mebendazole

Benjamin Speich  1   2 , Wendelin Moser  3   4 , Said M Ali  5 , Shaali M Ame  6 , Marco Albonico  7 , Jan Hattendorf  8   9 , Jennifer Keiser  10   11
Affiliations
Randomized Controlled Trial

Efficacy and reinfection with soil-transmitted helminths 18-weeks post-treatment with albendazole-ivermectin, albendazole-mebendazole, albendazole-oxantel pamoate and mebendazole

Benjamin Speich et al. Parasit Vectors. .

Abstract

Background: Preventive 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.

Methods: In 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.

Results: For 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).

Conclusion: The 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 registration: Current Controlled Trials ISRCTN80245406.

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Figures

Fig. 1
Fig. 1
Study design flow chart. Study enrolment, randomisation and two follow-ups (3 and 18 weeks post-treatment) for the four-arm, randomised controlled trial
Fig. 2
Fig. 2
Changes in T. trichiura infection patterns and infection intensities from the baseline to 3 and 18 weeks post-treatment with the four different treatments
Fig. 3
Fig. 3
Changes in A. lumbricoides infection patterns and infection intensities from the baseline to 3 and 18 weeks post-treatment with the four different treatments
Fig. 4
Fig. 4
Changes in hookworms infection patterns and infection intensities from the baseline to 3 and 18 weeks post-treatment with the four different treatments
See this image and copyright information in PMC

References

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