Low Efficacy of Single-Dose Albendazole and Mebendazole against Hookworm and Effect on Concomitant Helminth Infection in Lao PDR
Low Efficacy of Single-Dose Albendazole and Mebendazole against Hookworm and Effect on Concomitant Helminth Infection in Lao PDR
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DOI：
10.1371/journal.pntd.0001417
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发表时间：
2012-01-01
影响因子：
3.8
通讯作者：
Odermatt, Peter
中科院分区：
文献类型：
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作者：
Soukhathammavong, Phonepasong Aye;Sayasone, Somphou;Odermatt, Peter
背景：阿苯达唑和甲苯咪唑越来越多地用于针对土源性蠕虫(STH)感染的预防性化疗。我们评价了单剂口服阿苯达唑(400 Mg)和甲苯咪唑(500 Mg)治疗老挝人民民主共和国学龄儿童钩虫感染的疗效。由于在我们的研究环境中，间日圆线虫是共同流行的，所以这两种药物对这种肝吸虫的效果也可以确定。方法：我们进行了一项随机、开放标签的双臂试验。总共200名感染钩虫的儿童(通过来自两个粪便样本的四份Kato-Katz厚涂片确定)被随机分配到阿苯达唑组(n=100)和甲苯咪唑组(n=100)。治疗后21-23天的治愈率(CR；治疗后卵子阴性儿童的百分比)和卵子减少率(ERR；与基线相比，治疗后几何平均粪便卵数减少)被用作主要结果指标。主要结果：单剂阿苯达唑和甲苯咪唑的CRS分别为36.0%和17.6%(优势比：0.4；95%可信区间：0.2~0.8；P=0.01)，误差分别为86.7%和76.3%。阿苯达唑和甲苯咪唑在混合感染的儿童中CRS较低(分别为33.3%和24.2%)，中度错误(分别为82.1%和78.2%)。结论/意义：阿苯达唑和甲苯咪唑对钩虫的CRS均令人失望，但阿苯达唑治愈了钩虫感染，减轻了感染强度，疗效优于甲苯咪唑。单剂量给药显示了对抗间日圆线虫的效果，因此，监测预防性化疗策略的潜在辅助益处将是有趣的，该策略针对后胸吸虫病共同流行的地区的STH。
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.