Comparison of the efficacy of mebendazole, albendazole and pyrantel in treatment of human hookworm infections in the Southern Region of Mali, West Africa

Abstract

A randomized, placebo-controlled trial of the efficacy of pyrantel (single dose 12.5 mg/kg bodyweight), mebendazole (single 500 mg dose) and albendazole (single 400 mg dose) in the treatment of hookworm infections (Necator americanus) was carried out in January 1998 in the Southern Region of Mali, West Africa, during the period of Ramadan (Islamic fast). Statistical analysis of the pre-intervention faecal egg counts showed that there was a significant pre-treatment chance bias, despite randomization of subjects into treatment groups, arising from the main effect of sex (heavier infections among males) and a sex x treatment interaction (the sex bias was not evident in the pyrantel-treatment group). The participants were re-examined 10 days after treatment, and after controlling for the drift in faecal egg counts in the placebo-treated subset, age, sex, fasting and intensity of infection, albendazole was clearly the most effective drug showing consistently efficacies in the range 92.1 to 99.7%, depending on the method of evaluation and the particular subset of the treatment group. Neither mebendazole nor pyrantel was as effective, with efficacies ranging from 60.9 to 89.8% and 4.8 to 89.7%, respectively. Fasting made no difference to drug efficacy. On the basis of our results the single 400 mg dose of albendazole is the treatment of choice for hookworm infections in this region of Mali. We emphasize the need for standardization of the methods used for trial designs, for calculation of summary data relating to drug efficacies and the accompanying statistical tests.

Is anthelmintic resistance a concern for the control of human soil-transmitted helminths?

“…However, the significance of this difference in ED 50 is difficult to assess given the very different genetic backgrounds of the isolates. A similar study in the same region (Sacko et al, 1999) with a single dose of ALB 400 mg resulted in a CR of 51.4% and a ERR of 77.6%, both significantly higher than reported earlier by De Clercq et al (1997). Thus the studies fell short of providing conclusive evidence of AR against BZ in Mali.…”

“…To date all reports indicating disappointing efficacy among the BZs have concerned MEB, and even in studies where MEB had low efficacy (Sacko et al, 1999), ALB was used as the positive control and showed extremely high efficacy against hookworms (See also Vercruysse et al, 2011). It is therefore of some concern that a recent report from Ghana has indicated a high failure rate for ALB in the treatment of hookworm infections (Humphries et al, 2011).…”

A randomised trial in Mali of the effectiveness of weekly iron supplements given by teachers on the haemoglobin concentrations of schoolchildren

“…Any child with severe anaemia (haemoglobin concentration #80 g l 21 ) was excluded from the study and treated with ferrous sulphate. All children in every school were treated before the intervention began with 400 mg of albendazole (Medpharm, Washington DC, USA) to expel intestinal parasites, because hookworm is endemic in Sikasso Region 6 . A week later all children in every school were given a single capsule of 200 000 IU of vitamin A (Holden Medical, WEZEP, the Netherlands), because a survey had found that 4.5% of schoolchildren had reported nightblindness 7 .…”

Ramadan fasting and infectious diseases: a systematic review

“…Sacko et al [15] performed a randomized, singleblind, placebo-controlled trial in order to test whether the Ramadan fasting would compromise the efficacy of some anti-helminthic drugs. They tested pyrantel, mebendazole, and albendazole, which are used for the treatment of hookworm infections (Necator americanus).…”