Assessment of the anthelmintic efficacy of albendazole in school children in seven countries where soil-transmitted helminths are endemic.
Assessment of the anthelmintic efficacy of albendazole in school children in seven countries where soil-transmitted helminths are endemic.
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DOI：
10.1371/journal.pntd.0000948
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发表时间：
2011-03-29
影响因子：
3.8
通讯作者：
Levecke B
中科院分区：
文献类型：
--
作者：
Vercruysse J;Behnke JM;Albonico M;Ame SM;Angebault C;Bethony JM;Engels D;Guillard B;Nguyen TV;Kang G;Kattula D;Kotze AC;McCarthy JS;Mekonnen Z;Montresor A;Periago MV;Sumo L;Tchuenté LA;Dang TC;Zeynudin A;Levecke B
三种主要的土源性蠕虫 (STH)：蛔虫、鞭虫和美洲板口线虫/十二指肠钩口线虫是世界上分布最广的寄生虫。尽管预防性驱虫治疗在全球范围内扩展，但仍缺乏监测驱虫药物疗效的标准操作程序。因此，本研究的目的是使用标准化方案确定单次 400 毫克剂量的阿苯达唑 (ALB) 对这三种 STH 的功效。在巴西、喀麦隆、柬埔寨、埃塞俄比亚、印度、坦桑尼亚和越南的学童中进行了七项试验。使用麦克马斯特卵计数技术确定粪卵计数（FEC），通过治愈率（CR）和粪卵计数减少（FECR）来评估疗效。总体而言，观察到的 CR 最高的是线虫 (98.2%)，其次是钩虫 (87.8%) 和毛虫 (46.6%)。不同试验（国家）、年龄或干预前 FEC（治疗前）的不同，三种寄生虫的 CR 存在相当大的差异。后者可能是最重要的，因为它对所有三个 STH 的 CR 有相当大的影响。根据FECR反映，蛔虫（99.5%）和钩虫（94.8%）的治疗效果非常高，但毛线虫（50.8%）的治疗效果明显较低，并且在这3个物种中受到干预前FEC计数和试验（国家）不同程度的影响，但不受性别或年龄的影响。我们的研究结果表明，在未来的所有调查中，蚓螈的 FECR（基于算术平均值）>95% 和钩虫>90% 应该是预期的最低值，并且鉴于潜在的耐药性，单剂量 ALB 后低于此水平的治疗效果应予以关注。针对毛毛虫的功效标准阈值尚未确定，因为单剂量 ALB 不太可能满足这种寄生虫的需要。 ClinicalTrials.gov NCT01087099 土源性蠕虫（蛔虫、鞭虫和钩虫）感染（亚）热带国家数百万儿童，导致营养不良、生长迟缓、智力迟缓和认知缺陷。目前，有必要密切监测驱虫药物的疗效并制定标准操作程序，正如 2007 年底在华盛顿特区举行的世界卫生组织和世界银行关于“人类蠕虫病大规模治疗计划中的药物疗效监测”的会议所强调的那样。因此，我们使用 标准化协议。此外，还评估了分析数据的不同统计方法，以制定数据分析的标准化程序。结果表明，所应用的治疗对圆虫和钩虫非常有效，但对鞭虫无效。然而，不同试验的疗效存在很大差异，值得进一步关注。这项研究还为功效数据的统计分析提供了新的见解，在未来大规模驱虫治疗方案的监测和评估研究中应考虑这一点。最后，我们的研究结果强调需要更新世界卫生组织推荐的 STH 治疗疗效阈值。
The three major soil-transmitted helminths (STH) Ascaris lumbricoides, Trichuris trichiura and Necator americanus/Ancylostoma duodenale are among the most widespread parasites worldwide. Despite the global expansion of preventive anthelmintic treatment, standard operating procedures to monitor anthelmintic drug efficacy are lacking. The objective of this study, therefore, was to define the efficacy of a single 400 milligram dose of albendazole (ALB) against these three STH using a standardized protocol. Seven trials were undertaken among school children in Brazil, Cameroon, Cambodia, Ethiopia, India, Tanzania and Vietnam. Efficacy was assessed by the Cure Rate (CR) and the Fecal Egg Count Reduction (FECR) using the McMaster egg counting technique to determine fecal egg counts (FEC). Overall, the highest CRs were observed for A. lumbricoides (98.2%) followed by hookworms (87.8%) and T. trichiura (46.6%). There was considerable variation in the CR for the three parasites across trials (country), by age or the pre-intervention FEC (pre-treatment). The latter is probably the most important as it had a considerable effect on the CR of all three STH. Therapeutic efficacies, as reflected by the FECRs, were very high for A. lumbricoides (99.5%) and hookworms (94.8%) but significantly lower for T. trichiura (50.8%), and were affected to different extents among the 3 species by the pre-intervention FEC counts and trial (country), but not by sex or age. Our findings suggest that a FECR (based on arithmetic means) of >95% for A. lumbricoides and >90% for hookworms should be the expected minimum in all future surveys, and that therapeutic efficacy below this level following a single dose of ALB should be viewed with concern in light of potential drug resistance. A standard threshold for efficacy against T. trichiura has yet to be established, as a single-dose of ALB is unlikely to be satisfactory for this parasite. ClinicalTrials.gov NCT01087099 Soil-transmitted helminths (roundworms, whipworms and hookworms) infect millions of children in (sub)tropical countries, resulting in malnutrition, growth stunting, intellectual retardation and cognitive deficits. Currently, there is a need to closely monitor anthelmintic drug efficacy and to develop standard operating procedures, as highlighted in a World Health Organization–World Bank meeting on “Monitoring of Drug Efficacy in Large Scale Treatment Programs for Human Helminthiasis” in Washington DC at the end of 2007. Therefore, we have evaluated the efficacy of a commonly used treatment against these parasitic infections in school children in Africa, Asia and South-America using a standardized protocol. In addition, different statistical approaches to analyzing the data were evaluated in order to develop standardized procedures for data analysis. The results demonstrate that the applied treatment was highly efficacious against round- and hookworms, but not against whipworms. However, there was large variation in efficacy across the different trials which warrants further attention. This study also provides new insights into the statistical analysis of efficacy data, which should be considered in future monitoring and evaluation studies of large scale anthelmintic treatment programs. Finally, our findings emphasize the need to update the World Health Organization recommended efficacy threshold for the treatment of STH.
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影响因子：
3.3
作者：
Geerts, S;Gryseels, B
通讯作者：
Gryseels, B
影响因子：
3.8
作者：
Kotze, Andrew C.;Kopp, Steven R.
通讯作者：
Kopp, Steven R.
DOI：
10.4269/ajtmh.1996.55.477
发表时间：
1996-11-01
影响因子：
3.3
作者：
Marti, H;Haji, HJ;Hatz, C
通讯作者：
Hatz, C
影响因子：
3.8
作者：
Levecke, Bruno;De Wilde, Nathalie;Vercruysse, Jozef
通讯作者：
Vercruysse, Jozef
影响因子：
2.6
作者：
COLES, GC;BAUER, C;WALLER, PJ
通讯作者：
WALLER, PJ