Efficacy of Single-Dose and Triple-Dose Albendazole and Mebendazole against Soil-Transmitted Helminths and Taenia spp.: A Randomized Controlled Trial

Abstract

BackgroundThe control of soil-transmitted helminth (STH) infections currently relies on the large-scale administration of single-dose oral albendazole or mebendazole. However, these treatment regimens have limited efficacy against hookworm and Trichuris trichiura in terms of cure rates (CR), whereas fecal egg reduction rates (ERR) are generally high for all common STH species. We compared the efficacy of single-dose versus triple-dose treatment against hookworm and other STHs in a community-based randomized controlled trial in the People's Republic of China.Methodology/Principal findingsThe hookworm CR and fecal ERR were assessed in 314 individuals aged ≥5 years who submitted two stool samples before and 3–4 weeks after administration of single-dose oral albendazole (400 mg) or mebendazole (500 mg) or triple-dose albendazole (3×400 mg over 3 consecutive days) or mebendazole (3×500 mg over 3 consecutive days). Efficacy against T. trichiura, Ascaris lumbricoides, and Taenia spp. was also assessed.Albendazole cured significantly more hookworm infections than mebendazole in both treatment regimens (single dose: respective CRs 69% (95% confidence interval [CI]: 55–81%) and 29% (95% CI: 20–45%); triple dose: respective CRs 92% (95% CI: 81–98%) and 54% (95% CI: 46–71%)). ERRs followed the same pattern (single dose: 97% versus 84%; triple dose: 99.7% versus 96%). Triple-dose regimens outperformed single doses against T. trichiura; three doses of mebendazole – the most efficacious treatment tested – cured 71% (95% CI: 57–82%). Both single and triple doses of either drug were highly efficacious against A. lumbricoides (CR: 93–97%; ERR: all >99.9%). Triple dose regimens cured all Taenia spp. infections, whereas single dose applications cured only half of them.Conclusions/SignificanceSingle-dose oral albendazole is more efficacious against hookworm than mebendazole. To achieve high CRs against both hookworm and T. trichiura, triple-dose regimens are warranted.Trial Registration www.controlled-trials.com ISRCTN47375023

Rapid Re-Infection with Soil-Transmitted Helminths after Triple-Dose Albendazole Treatment of School-Aged Children in Yunnan, People's Republic of China

“…China. However, they are comparable to reports by Steinmann and co-workers 34 from other Bulang communities characterized by similar socio-ecological contexts where multiple species helminth infection was also common. 11,[20][21][22] Taken together, these data emphasize that, although P.R.…”

“…Indeed, the cure rate of only 19.6% for T. trichiura as observed in our trial is much lower than that reported from a previous trial with triple-dose albendazole treatment in the same area (56%). 34 It is difficult to explain these observations because sampling and diagnostic efforts were comparable and the same field team was involved in both trials. It should be noted, however that from a public health point of view, the egg reduction rate rather than the cure rate should be considered when determining anthelmintic drug efficacy.…”

Randomized, Controlled, Assessor-Blind Clinical Trial To Assess the Efficacy of Single- versus Repeated-Dose Albendazole To Treat Ascaris lumbricoides, Trichuris trichiura, and Hookworm Infection

“…Reports are available from Cameroon, Ethiopia, and Tanzania, with cure rates ranging from 93 to 99% and from 69 to 93% (33)(34)(35), respectively.…”

A study of prevalence of intestinal worm infestation and efficacy of anthelminthic drugs

“…Yunnan, observed a CR of 96.7%, 91.5%, and 19.6% for hookworm, A. lumbricoides, and T. trichiura, respectively; while Steinmann et al (2011) 17 in single-dose versus triple dose treatment trial against hookworm and other STHs in a community based randomized controlled trial in the People's Republic of China, observed albendazole cured significantly more hookworm infections than mebendazole in both treatment regimens (single-dose: respective CRs e 69% (55e81%) and 29% (20e45%); triple dose: respective CRs 92% (81e98%) and 54% (46e71%)). The above studies suggest that the CRs obtained with single-oral dose of ALB & MBZ against STH and other nematodes seldom achieve complete cure.…”