Low efficacy of single-dose albendazole and mebendazole against hookworm and effect on concomitant helminth infection in Lao PDR.

Abstract

BACKGROUND:

Albendazole and mebendazole are increasingly deployed for preventive chemotherapy targeting soil-transmitted helminth (STH) infections. We assessed the efficacy of single oral doses of albendazole (400 mg) and mebendazole (500 mg) for the treatment of hookworm infection in school-aged children in Lao PDR. Since Opisthorchis viverrini is co-endemic in our study setting, the effect of the two drugs could also be determined against this liver fluke.

METHODOLOGY:

We conducted a randomized, open-label, two-arm trial. In total, 200 children infected with hookworm (determined by quadruplicate Kato-Katz thick smears derived from two stool samples) were randomly assigned to albendazole (n=100) and mebendazole (n=100). Cure rate (CR; percentage of children who became egg-negative after treatment), and egg reduction rate (ERR; reduction in the geometric mean fecal egg count at treatment follow-up compared to baseline) at 21-23 days posttreatment were used as primary outcome measures. Adverse events were monitored 3 hours post treatment.

PRINCIPAL FINDINGS:

Single-dose albendazole and mebendazole resulted in CRs of 36.0% and 17.6% (odds ratio: 0.4; 95% confidence interval: 0.2-0.8; P=0.01), and ERRs of 86.7% and 76.3%, respectively. In children co-infected with O. viverrini, albendazole and mebendazole showed low CRs (33.3% and 24.2%, respectively) and moderate ERRs (82.1% and 78.2%, respectively).

CONCLUSIONS/SIGNIFICANCE:

Both albendazole and mebendazole showed disappointing CRs against hookworm, but albendazole cured infection and reduced intensity of infection with a higher efficacy than mebendazole. Single-dose administrations showed an effect against O. viverrini, and hence it will be interesting to monitor potential ancillary benefits of a preventive chemotherapy strategy that targets STHs in areas where opisthorchiasis is co-endemic.

CLINICAL TRIAL REGISTRATION:

Current Controlled Trials ISRCTN29126001.

• Authors: Phonepasong Ayé Soukhathammavong, Somphou Sayasone, Khampheng Phongluxa, Vilavanh Xayaseng, Jürg Utzinger, Penelope Vounatsou, Christoph Hatz, Kongsap Akkhavong, Jennifer Keiser, Peter Odermatt
• Journal: PLoS neglected tropical diseases (PLoS Negl Trop Dis) Vol. 6 Issue 1 Pg. e1417 (Jan 2012) ISSN: 1935-2735 [Electronic] United States
• PMID: 22235353 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2012 Soukhathammavong et al.

Chemical References

• Anthelmintics
• Mebendazole
• Albendazole

Topics

• Albendazole (administration & dosage, adverse effects)
• Animals
• Anthelmintics (administration & dosage, adverse effects)
• Child
• Feces (parasitology)
• Female
• Hookworm Infections (drug therapy)
• Humans
• Laos
• Male
• Mebendazole (administration & dosage, adverse effects)
• Opisthorchiasis (drug therapy)
• Parasite Egg Count
• Treatment Outcome