Safety of integrated preventive chemotherapy for neglected tropical diseases

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.

Mass drug administration for neglected tropical disease control and elimination: a systematic review of ethical reasons

“…Between 2016 and 2019, more than 1 billion people received PC each year, resulting in significant reductions in morbidity, reduced transmission, and for some NTDs, regional elimination as a public health problem 28…”

“…Between 2016 and 2019, more than 1 billion people received PC each year, resulting in significant reductions in Global Health morbidity, reduced transmission, and for some NTDs, regional elimination as a public health problem. 28 Moreover, decrease of disease transmission averts DALYs in many population groups including uninfected people and future generations.…”

Feasibility and safety of integrating mass drug administration for helminth control with seasonal malaria chemoprevention among Senegalese children: a randomized controlled, observer-blind trial

“…More importantly, the collaborative support provided by the Senegal national malaria and NTD control programmes made the implementation of the integrated strategy logistically feasible. These factors have been documented to be effective strategies in the vertical implementation of MDA and SMC in most African settings [ 25 , 27 , 28 ]. Therefore, replicating the strategies in implementing an integrated approach in malaria-helminth co-endemic countries will optimize SMC and NTD control programmes.…”

“…This finding resonated with the feedback obtained through qualitative interviews conducted among the parents/caregivers of the children enrolled in this trial, during which they expressed concerns about the bitter taste, smell, and vomiting-induced effect of praziquantel [ 29 ]. Previous studies have also documented the increased incidence of these adverse events with praziquantel [ 28 , 30 ]. Amodiaquine, which is a partner drug in the SMC regimen, has also been reported to cause nausea and vomiting in children [ 31 ], but this was not a significant issue in this study.…”

Perceptions and acceptability of co-administered albendazole, ivermectin and azithromycin mass drug administration, among the health workforce and recipient communities in Ethiopia

“…Central or fixed-point MDAs are used for many NTD elimination and control programmes. Previous studies have found that bringing the entire community together saves on both cost and time compared to house-to-house treatment, in particular in communities where houses are far apart and difficult to reach [ 11 , 12 ]. A downside of this approach is that it shifts much of the participation burden on to communities and may create barriers to access.…”