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Review
. 2022 Sep 29;16(9):e0010700.
doi: 10.1371/journal.pntd.0010700. eCollection 2022 Sep.

Safety of integrated preventive chemotherapy for neglected tropical diseases

Allan M Ciciriello  1 , Jessica K Fairley  2 , Emma Cooke  3 , Paul M Emerson  1 , Pamela J Hooper  1 , Birgit Bolton  4 , Genevieve LaCon  1 , David G Addiss  5
Affiliations
Review

Safety of integrated preventive chemotherapy for neglected tropical diseases

Allan M Ciciriello et al. PLoS Negl Trop Dis. .

Abstract

Background: Preventive chemotherapy (PC) is a central strategy for control and elimination of neglected tropical diseases (NTDs). Increased emphasis has been given to "integration" of NTD programs within health systems and coadministration of NTD drugs offers significant programmatic benefits. Guidance from the World Health Organization (WHO) reflects current evidence for safe drug coadministration and highlights measures to prevent choking of young children during PC.

Methodology: To understand how coadministration of NTD drugs might affect PC safety, we reviewed literature on choking risk in young children and safety of coadministered NTD drugs. To understand current practices of drug coadministration, we surveyed 15 NTD program managers and implementing partners.

Principal findings: In high-income countries, choking on medication is an infrequent cause of death in young children. In low-resource settings, data are limited, but age-appropriate drug formulations are less available. During PC, fatal choking, although infrequent, occurs primarily in young children; forcing them to swallow tablets appears to be the major risk factor. The WHO currently recommends 6 drugs and 5 possible drug combinations for use in PC. Of 105 nations endemic for the 5 PC-NTDs, 72 (68.6%) are co-endemic for 2 or more diseases and could benefit from drug coadministration during PC. All 15 survey respondents reported coadministering medications during PC. Reported responses to a child refusing to take medicine included: not forcing the child to do so (60.0%), encouraging the child (46.7%), bringing the child back later (26.7%), offering powder for oral suspension (POS) for azithromycin (13.3%), and having parents or community members intervene to calm the child (6.7%).

Conclusions: Coadministration of NTD drugs during PC appears to be increasingly common. Safety of coadministered PC drugs requires attention to choking prevention, use of approved drug combinations, and increased access to age-appropriate drug formulations.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: GL, PJH, and PME are employees of the International Trachoma Initiative, which receives the majority of its funding from Pfizer Inc. for the management of Zithromax donations for trachoma elimination. The authors alone are responsible for the views expressed in this article, which do not necessarily represent the views, decisions or policies of the International Trachoma Initiative or Task Force for Global Health.

Figures

Fig 1
Fig 1. NTD drug coadministration safety Evidence strength.
Green lines represent WHO-recommended combinations. Red lines represent non-WHO-recommended combinations. Thicker lines represent more available safety data. (a) Personal communication, Drs. Jonathan King and Denise Mupfasoni, WHO; data from 2010–2020. ALB, albendazole; AZI, azithromycin; DEC, diethylcarbamazine; IVM, ivermectin; MEB, mebendazole; PZQ, praziquantel.
See this image and copyright information in PMC

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