Efficacy of Mebendazole and Praziquantel against Soil-Transmitted Helminths and Schistosoma mansoni Infections among Schoolchildren in Northwest Ethiopia

Background. Soil-transmitted helminths (STHs) and Schistosoma mansoni are the main causes of morbidity among schoolchildren in the tropics. A school-based deworming program was launched to control and eliminate the infection in endemic countries including Ethiopia. Although periodic deworming is conducted in endemic areas, the prevalence of the infection is high in the country. In addition, periodic evaluation of the efficacy of the anthelminthic drug is limited. Objective. This study is aimed at checking the efficacy of mebendazole and praziquantel with the respective STHs and Schistosoma mansoni parasites. Methods. A longitudinal study was conducted from February to March 2018 among 422 schoolchildren. Stool samples were collected at baseline and at 2 and 4 weeks posttreatment and were processed using the Kato-Katz technique. Schoolchildren positive for STHs were treated with mebendazole and those positive for Schistosoma mansoni with praziquantel. After two weeks, a second round of stool was collected and examined, and then, single-dose redosing was given to each positive child. Lastly, the third stool sample was collected two weeks after the initiation of the redosing and checked for STHs and S. mansoni parasites. A close follow-up of students who were treated was done. All the data were entered and analyzed using SPSS version 20 for analysis. Descriptive statistics was used to compute the cure rate and egg reduction rate of mebendazole and praziquantel. Results. Among 422 participants, the prevalence of STHs, hookworm, Ascaris lumbricoides, and S. mansoni was 44.7%, 35.1%, 21.1%, and 13.9%, respectively. The cure rate of mebendazole against A. lumbricoides increased from 60% in the single dose to 100% in redosing after two weeks. The cure rate of mebendazole against hookworm also increased from 32.4% in the single dose to 91.0% in the redosing. The cure rate of praziquantel against S. mansoni-infected children was 91.5% in the first round and 100% in the redosing phase. There was a 98.6-100% egg reduction rate in the redosing regimen of both drugs. Conclusion. The cure and egg reduction rates of single-dose mebendazole in the treatment of hookworm and A. lumbricoides are lower at week two than at redosing, while cure and egg reduction rates of single-dose praziquantel are satisfactory to treat S. mansoni. Therefore, single-dose praziquantel to S. mansoni and redosing of single-dose mebendazole to A. lumbricoides and hookworm infections can be used for treatment purposes.

Efficacy of Albendazole Against Soil-transmitted Helminthiasis among Children in Asia: Systematic Review

BACKGROUND: The World health organization reported that 875 million children worldwide require antihelminth preventive chemotherapy annually. Vast majority of STH infections (67%) and YLDs (68%) occurred in Asia. METHODS: A systematic search was performed for relevant titles, abstract, and keywords from Cochrane Library, PubMed, and Scopus around October 2018 based on the PICO strategy. Out of 173 papers that were evaluated, final assessment for eligibility had yielded a total of five papers to be included for analysis covering period from 2013 to 2018. RESULTS: Of the five selected studies, three were randomized controlled trial, one was cohort and another one was described more like a quasi-experimental trial. All infection intensity showed improvement post-intervention. Four of the five studies used Kato Katz as diagnostic method with one combined it with Baermann techniques. One used McMaster egg counting method. All except one study tested albendazole efficacy in their study either alone or in combination with other chemotherapy such as diethyl carbazide or combining with education pamphlet. Egg reduction rate was reported as low as 63% and as high as 99.9%. CONCLUSION: In general, albendazole is efficacious enough to control STH.

Efficacy of Different Drugs in Treating Urinary Schistosomiasis: Systematic Review and Network Meta-analysis

Background Praziquantel is the current pillar for morbidity control of schistosomiasis. Artesunate and its derivatives, widely used for malaria treatment, also display antischistosomal activities. This review compares the efficacy of three drugs, namely praziquantel (PZQ), artesunate, and metrifonate in urinary schistosomiasis. Methods Databases were searched for articles comparing the effectiveness of any of the three drugs to other medications or controls in urinary schistosomiasis in children aged 18 or less. Stata software was opted to generate the network meta-analysis. Efficacy (Cure rate and egg reduction rate) was the main outcome measure. Pairwise and network meta-analysis were used to report Odds Ratios (ORs) with either 95% confidence interval (CI) for direct comparisons or 95% credible intervals (CrI) for indirect comparisons. Results The SUCRA plot for cure rate revealed that PZQ (SUCRA= 40.4%) was the fourth effective drug after albendazole 400mg (SUCRA= 71.5), metrifonate 5 mg (SUCRA= 62.2%), and metrifonate 10 mg (SUCRA= 59.7). PZQ was only superior to metrifonate 7.5 mg. ORs were PZQ 40 mg (OR 0.48; 95% CI -3.55 to 4.51; p-value 0.816), artesunate 6 mg (OR 0.06; 95% CI -5.67 to 5.79; p-value 0.983), metrifonate 5 mg (OR -1.65; 95% CI -7.52 to 4.21; p-value 0.581), metrifonate 10 mg (OR -1.76; 95% CI -8.86 to 5.34; p-value 0.628), and metrifonate 7.5 mg (OR -2.40; 95% CI -9.78 to 4.98; p-value 0.524). A similar plot for egg reduction rate showed an exclusive superiority of PZQ 40 mg (SUCRA= 94.4%), followed by metrifonate 10mg (SUCRA= 82.3%) and niridazole 25mg plus metrifonate 10mg (SUCRA= 48.6%). Conclusions Our network analysis revealed that PZQ 40 mg was the most efficient drug in reducing egg count, whereas albendazole 400mg showed the highest cure rates.

Efficacy of Different Drugs in Treating Urinary Schistosomiasis: Systematic Review and Network Meta-analysis

Background: Praziquantel is the current pillar for morbidity control of schistosomiasis. Artesunate and its derivatives, widely used for malaria treatment, also display antischistosomal activities. This review compares the efficacy of three drugs, namely praziquantel (PZQ), artesunate, and metrifonate in urinary schistosomiasis. Methods: Databases were searched for articles comparing the effectiveness of any of the three drugs to other medications or controls in urinary schistosomiasis in children aged 18 or less. Stata software was opted to generate the network meta-analysis. Efficacy (Cure rate and egg reduction rate) was the main outcome measure. Pairwise and network meta-analysis were used to report Odds Ratios (ORs) with either 95% confidence interval (CI) for direct comparisons or 95% credible intervals (CrI) for indirect comparisons. Results: The SUCRA plot for cure rate revealed that PZQ (SUCRA= 40.4%) was the fourth effective drug after albendazole 400mg (SUCRA= 71.5), metrifonate 5 mg (SUCRA= 62.2%), and metrifonate 10 mg (SUCRA= 59.7). PZQ was only superior to metrifonate 7.5 mg. ORs were PZQ 40 mg (OR 0.48; 95% CI -3.55 to 4.51; p-value 0.816), artesunate 6 mg (OR 0.06; 95% CI -5.67 to 5.79; p-value 0.983), metrifonate 5 mg (OR -1.65; 95% CI -7.52 to 4.21; p-value 0.581), metrifonate 10 mg (OR -1.76; 95% CI -8.86 to 5.34; p-value 0.628), and metrifonate 7.5 mg (OR -2.40; 95% CI -9.78 to 4.98; p-value 0.524). A similar plot for egg reduction rate showed an exclusive superiority of PZQ 40 mg (SUCRA= 94.4%), followed by metrifonate 10mg (SUCRA= 82.3%) and niridazole 25mg plus metrifonate 10mg (SUCRA= 48.6%). Conclusions: Our network analysis revealed that PZQ 40 mg was the most efficient drug in reducing egg count, whereas albendazole 400mg showed the highest cure rates.

Efficacy of a Single Dose versus Triple Dose Regimen of Mebendazole against Hookworm Infection among School Children: A Randomized, Single blinded Trial.

Background: The current control efforts against soil transmitted helminthic infection focused on reducing morbidity and transmission potential through periodic anthelminthic chemotherapy of single dose of mebendazole and albendazole regimen. Single dose mebendazole is one of extensively applicable drug regimen as a preventive chemotherapy in hookworm endemic areas. However, nowadays, studies reveal single dose treatment regimen has poor and unsatisfactory efficacy status against hookworm infection. We evaluated the efficacy status of single dose (500mg) versus triple dose (100mg) of mebendazole against hookworm infection among school aged children.Methods: This randomized, single-blinded clinical trial took place in a primary school on Burie and Debre Elias towns, Northwest Ethiopia among school-aged children (6-14). Using simple randomization, eligible hookworm positive children were randomly allocated (1:1) to either a single dose or triple dose of mebendazole arm. Stool samples were collected at baseline and follow-up period (14-21 days after treatment) for McMaster analysis. The primary and secondary outcome measures in this study were cure rate (CR) and egg reduction rate (ERR), respectively. Results were displayed using tables and figure. Independent t test was used to compare group means, logistic regression was used to calculate odds ratio (OR), and P-value < 0.05 at 95% CI was considered for statistical significance.Result: 109 children were allocated for each treatment arm and 103 children were completed the drug efficacy follow up study. Cure rate against hookworm was significantly higher in triple dose (96.1%) than in single dose (30.8%) with (OR=55.125; 95% CI: 11.92-254.9; P < 0.001). Egg reduction rate against hookworm infection in triple dose (99.5%) was also significantly higher than single dose (68.9%) with difference t (101) =5.38; 95% CI 230.95-505.36; P < 0.001.Conclusion: Single dose regimen of mebendazole for the treatment of hookworm infection showed poor efficacy, while triple dose revealed satisfactory efficacy. Therefore, we recommend for giving special emphasis on current deworming program which implemented through single dose mebendazole for hookworm endemic area.

Integrated community-based intervention for urinary schistosomiasis and soil-transmitted helminthiasis in children from Caxito, Angola

Background Schistosomiasis and soil-transmitted helminths (STH) infections are major public health problems. We aimed to study the 6-mo impact of mass drug administration with praziquantel and albendazole on urinary schistosomiasis and STH. Methods We examined children (aged 2–15 y) from one hamlet, who provided urine and faeces samples at baseline (n=197), 1 mo (n=102) and 6 mo (n=92); 67 completed the protocol. Results At baseline, 47/67 (70.1%) children presented Schistosoma haematobium (75.8% in the baseline total sample) and 12/67 (17.9%) with STH (30.5% in the initial sample, p=0.010). Among the children, 47.3% had heavy Schistosoma haematobium infection. The most frequent STH was Trichuris trichiura in 9.0%. We also found Hymenolepis nana (13.2%) and Plasmodium falciparum (9.1%) infections and anaemia (82.1%). One mo after chemotherapy there was a significant (p=0.013) reduction of Schistosoma haematobium prevalence (23.5%) and a high egg reduction rate (86.9%). Considering the sample of 67 children, the mean egg concentration was 498 at baseline, 65 at 1 mo and 252 at 6 mo (p&lt;0.05). We also observed a reduction in STH infections, 50% in Ascaris lumbricoides, 33.3% in T. trichiura and 50% in hookworms. At 6 mo, the prevalence of Schistosoma haematobium (76.1%) was similar to the baseline and the STH reduction was not significant. Conclusions Longitudinal studies have reported many losses in these settings, but we were able to show that mass drug administration for control of schistosomiasis and STH present low effectiveness, that reinfections occur rapidly and that stand alone anthelmintic therapy is not a sustainable choice.

THE EFFECTIVENESS OF TRIPLE-DOSE ALBENDAZOLE IN COMPARISON WITH MEBENDAZOLE FOR THE TREATMENT OF TRICHURIASIS IN CHILDREN

Objective: Trichuriasis is difficult to treat with single-dose anthelmintic. Although a higher cure rate (CR) can be achieved by treatment with triple-dose albendazole and mebendazole, the results of studies are inconsistent. This study aimed to evaluate the effectiveness of triple-dose albendazole and mebendazole in treating trichuriasis. Methods: A randomized controlled trial was conducted in a primary school in the Pandeglang District, Banten Province, Indonesia in July–August, 2018; 382 children were recruited. Stools were collected and examined microscopically using the Kato–Katz method to identify Trichuriasis eggs. Children positive for Trichuris trichiura were randomized and divided into two groups. One was given a triple dose of 400 mg albendazole and the other a triple dose of 500 mg mebendazole. On day 14 after treatment, stools were reexamined to calculate CR and the egg reduction rate (ERR). Data were analyzed using SPSS version 20. Results: The prevalence of soil-transmitted helminth infection was 42%, and that of trichuriasis and ascariasis was 25.1% and 29.8%. There was a significant difference (Wilcoxon test, P<0.01) in the intensity of infection before and after intervention. Both groups showed high values of CR (mebendazole: 95.2%, albendazole: 85.4%; Fisher’s exact test, P = 0.125) and ERR (mebendazole: 99%, albendazole: 96%; Mann–Whitney test, P = 0.110). There was no significant difference in CR and ERR between the two groups. Conclusion: Triple-dose albendazole was as effective as triple-dose mebendazole in treating trichuriasis.

The Effectiveness of Triple Dose Albendazole in Treating Soil Transmitted Helminths Infection

Soil transmitted helminths (STH) infection is a major health problem in tropical countries such as Indonesia. Albendazole is an effective and widely used anthelmintic agent to treat STH; however, it is not effective towards T. trichiura and its effectiveness varies between populations. Hence, we conducted a study to determine the effectiveness of triple dose albendazole in children of Perobatang village, Southwest Sumba, Indonesia. A pre-post study was carried out in Perobatang village on July 2016. Children aged 1-15 years old were enrolled in the study and asked to collect stool samples which were then examined using Kato-Katz method. The children infected with STH were given albendazole 400 mg for three consecutive days. From 246 subjects examined, 192 (78%) were positive for any STH consisting of T. trichiura (64%), A. lumbricoides (60%), and hookworms (10%). After treatment, the prevalence of STH decreased significantly (McNemar test, p<0.001) to 27%, T. trichiura 25%, A. lumbricoides 2%, and hookworm 0%. Cure rate for T. trichiura, A. lumbricoides, and hookworms was 61%, 97%, and 100%, respectively. Significant decrease of eggs per gram of feces was found in all STH (Wilcoxon test, p value <0.001 for A. lumbricoides and T. trichiura, p value = 0.027 for hookworms); egg reduction rate for T. trichiura was 91%, A. lumbricoides was 100%, and hookworms was 100%. In conclusion, triple dose albendazole is effective in controlling STH in children of Perobatang village, Southwest Sumba, Indonesia.