A comparison of the efficacy of single doses of albendazole, ivermectin, and diethylcarbamazine alone or in combinations against Ascaris and Trichuris spp.
Vicente Y. BelizarioMaría E. AmarilloWinifreda U. de LeonA E de los ReyesM G BugayongBernard Macatangay
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Abstract:
To determine the efficacy of single doses of albendazole, ivermectin and diethylcarbamazine, and of the combinations albendazole + ivermectin and albendazole + diethylcarbamazine against common intestinal helminthiases caused by Ascaris and Trichuris spp.In a randomized, placebo-controlled trial, infected children were randomly assigned to treatment with albendazole + placebo, ivermectin + placebo, diethylcarbamazine + placebo, albendazole + ivermectin, or albendazole + diethylcarbamazine. The Kato-Katz method was used for qualitative and quantitative parasitological diagnosis. The chi2 test was used to determine the significance of cure rates, repeated measures analysis of variance for the comparison of mean log egg counts, the Newman-Keuls procedure for multiple comparison tests, and logistic regression for the comparison of infection rates at days 180 and 360 after treatment.Albendazole, ivermectin and the drug combinations gave significantly higher cure and egg reduction rates for ascariasis than diethylcarbamazine. For trichuriasis, albendazole + ivermectin gave significantly higher cure and egg reduction rates than the other treatments: the infection rates were lower 180 and 360 days after treatment.Because of the superiority of albendazole + ivermectin against both lymphatic filariasis and trichuriasis, this combination appears to be a suitable tool for the integrated or combined control of both public health problems.Keywords:
Albendazole
Diethylcarbamazine
Trichuriasis
Trichuris
Lymphatic Filariasis
Hookworm Infections
Ascaris
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Ceylon Medical Journal (CMJ) is a peer-reviewed, open access journal published quarterly by the Sri Lanka Medical Association in the last week of March, June, September and December each year. The mission of the CMJ is to promote the science and art of medicine and betterment of public health. The Journal publishes original papers and commentaries which have relevance to medicine and allied sciences. The CMJ is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.
Albendazole
Diethylcarbamazine
Lymphatic Filariasis
Hookworm Infections
Mass drug administration
Sri lanka
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Citations (21)
Annual mass treatment with antifilarial drugs is the cornerstone of the global program to eliminate lymphatic filariasis (LF). Although the primary goal of the program is to interrupt transmission of LF, additional public health benefits also are expected because of the known anthelminthic properties of these drugs. Since rapid re-infection with intestinal helminths occurs following treatment, annual de-worming may not be sufficient to produce a lasting reduction in the prevalence and intensity of these infections. We conducted stool examinations in four sentinel communities before and approximately nine months after each of two rounds of mass drug administration (MDA) with diethylcarbamazine and albendazole in the context of an LF elimination program in Leogane, Haiti. At baseline, overall Ascaris, Trichuris, and hookworm infection prevalences were 20.9%, 34.0%, and 11.2%, respectively (n = 2,716 stools). Nine months after the second MDA, Ascaris, Trichuris and hookworm prevalences had decreased significantly, to 14.1%, 14.6%, and 2.0%, respectively (n = 814 stools). Infection intensity decreased significantly for all three parasites as well. These results demonstrate that substantial reductions in intestinal helminth infections are associated with mass treatment of filariasis in Haiti and are consistent with the conclusion that high levels of coverage for the LF program can decrease transmission of geohelminths.
Albendazole
Trichuris
Lymphatic Filariasis
Diethylcarbamazine
Ascaris
Trichuriasis
Hookworm Infections
Mass drug administration
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An overall reduction of helminths after four mass drug administrations spread over 4 years was 78% and 26% in the diethylcarbamazine plus albendazole and diethylcarbamazine alone arms, respectively (unpublished data). Among the three intestinal helminths examined, an impact of both drug regimens was noticed only on Ascaris spp. For the other two helminth infections—Trichuris spp and hookworm— reduction was observed only in the diethylcarbamazine plus albendazole arm, while an increase (both in egg prevalence and intensity) was observed in the diethylcarbamazine alone arm. The ineffectiveness of diethylcarbamazine on hookworm and Trichuris spp may have sustained the transmission of the parasite to other susceptible hosts. The burden of hookworm infection outranks African trypanosomiasis, Chagas disease, shistosomiasis, and leprosy. 10 Hookworm burden increases with age, by contrast with the burden of the other two helminths, which is highest in children. The high egg intensity of hookworm was found among 30–50-year-old people, and in those over the age of 60 years, 11
Diethylcarbamazine
Albendazole
Trichuris
Ascaris
Hookworm Infections
Hookworm Infections
Trichuriasis
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Albendazole, a broad spectrum anthelmintic, was administered as a 400 mg single dose to 20 patients harbouring Ascaris (ten cases), hookworms (four cases each of Ancylostoma duodenale and Necator americanus) and trichuriasis (ten cases). Faeces were obtained before treatment and during the following five days. Coprocultures were made for 90 days for Ascaris and Trichuris eggs, hookworm eggs were cultured by the Harada-Mori technique for at least eight days. Albendazole was ovicidal against all four genera of nematodes.
Ancylostomiasis
Trichuriasis
Albendazole
Hookworm Infections
Hookworm Infections
Ancylostoma
Pyrantel
Trichuris
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The Programme to Eliminate Lymphatic Filariasis (LF), launched in 1997, is a public-sector/private- sector partnership organized as a Global Alliance, with the World Health Organization serving as secretariat. Its principal purpose is to carry out the mandate of the 50th World Health Assembly (1997) to eliminate lymphatic filariasis as a public health problem worldwide, but its tools and strategies for achieving this end also have important additional public health benefits. Foremost among these are the effects the Programme can have on the control of intestinal helminth infections in treated populations, largely because of certain similarities, or overlaps, of the drugs and strategies used in the public health approaches to these parasitic infections. The principal health benefits from treating these intestinal helminth infections are reviewed in detail below, but in addition there might even be an entirely new justification for aggressive treatment and control of these infections if the recently described effects they have on potentiating HIV infections in affected populations can also be further substantiated and extended.
Lymphatic Filariasis
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To determine the efficacy of single doses of albendazole, ivermectin and diethylcarbamazine, and of the combinations albendazole + ivermectin and albendazole + diethylcarbamazine against common intestinal helminthiases caused by Ascaris and Trichuris spp.In a randomized, placebo-controlled trial, infected children were randomly assigned to treatment with albendazole + placebo, ivermectin + placebo, diethylcarbamazine + placebo, albendazole + ivermectin, or albendazole + diethylcarbamazine. The Kato-Katz method was used for qualitative and quantitative parasitological diagnosis. The chi2 test was used to determine the significance of cure rates, repeated measures analysis of variance for the comparison of mean log egg counts, the Newman-Keuls procedure for multiple comparison tests, and logistic regression for the comparison of infection rates at days 180 and 360 after treatment.Albendazole, ivermectin and the drug combinations gave significantly higher cure and egg reduction rates for ascariasis than diethylcarbamazine. For trichuriasis, albendazole + ivermectin gave significantly higher cure and egg reduction rates than the other treatments: the infection rates were lower 180 and 360 days after treatment.Because of the superiority of albendazole + ivermectin against both lymphatic filariasis and trichuriasis, this combination appears to be a suitable tool for the integrated or combined control of both public health problems.
Albendazole
Diethylcarbamazine
Trichuriasis
Trichuris
Lymphatic Filariasis
Hookworm Infections
Ascaris
Cite
Citations (157)
This randomized, placebo-controlled trial investigated the efficacy and nutritional benefit of combining chemotherapeutic treatment for intestinal helminths (albendazole) and lymphatic filariasis (ivermectin). Children were infected with Ascaris (29.2%), Trichuris (42.2%), and hookworm (6.9%), with 54.7% of children having one or more of these parasites. Wuchereria bancrofti microfilaria were found in 13.3% of the children. Children were randomly assigned to treatment with placebo, albendazole, ivermectin, or combined therapy. Combination treatment reduced the prevalence of Trichuris infections significantly more than either drug alone. Combination therapy also significantly reduced the prevalence and density of W. bancrofti microfilaremia compared with placebo or ivermectin alone. Only combination therapy resulted in significantly greater gains in height (hookworm-infected children) or weight (Trichuris-infected children) compared with the placebo group. Combined albendazole and ivermectin was a more efficacious treatment for intestinal helminth and W. bancrofti infections in children and resulted in nutritional benefits not found with either drug alone.
Albendazole
Lymphatic Filariasis
Trichuris
Trichuriasis
Hookworm Infections
Hookworm Infections
Microfilaria
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Citations (162)
A comparison of two studies performed in Sierra Leone on the effect of anthelmintic, chemotherapy, levamisole, albendazole or a placebo in children aged 6 to 10 years on the prevalence and intensity of common soil transmitted helminths (S-THs) infections is presented. In total 501 children were screened, and 394 successfully follow-up. At baseline their overall prevalence and intensity (epg) of Ascaris, Necator and Trichuris were 34% (2,877), 22% (284) and 39% (266) respectively. At baseline there was no significant difference in the intensity of S-THs infections in the different treatment groups but the prevalence of Necator was significantly higher in the levamisole than the albendazole group (p < 0.05). At follow-up both albendazole and levamisole significantly reduced prevalence and intensity of Ascaris and Trichuris. Only albendazole significantly reduced those of Necator. The placebo group had no significant change in prevalence but a significant increase in intensity of all S-THs.
Albendazole
Levamisole
Hookworm Infections
Trichuriasis
Ascaris
Trichuris
Hookworm Infections
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Diethylcarbamazine (DEC) is an important drug for treatment and control of lymphatic filariasis. To assess its possible effect on Ascaris and hookworm infections, we conducted a double‐blind two‐armed study with children in Tanzania. Twenty six Ascaris ‐infected children were given a single dose of DEC (6 mg/kg body weight) and 25 were given a placebo. Twenty children in the treatment group and eighteen controls were also infected with hookworms. One month after treatment the geometric mean intensity (GMI) of Ascaris egg output was reduced by 60.2% in the treatment group; two children (7.7%) had stopped excreting Ascaris eggs, and some Ascaris worms were also expelled. In hookworm‐infected children in the treatment group, the geometric mean intensity of hookworm egg output was reduced by 6.7% 1 month after treatment. Neither for Ascaris nor for hookworm, however, was the observed reduction in egg output at 1 month after treatment statistically significant. The treatment efficacy of a single dose of DEC (6 mg/kg) in these infections therefore was low.
Ascaris
Hookworm Infections
Hookworm Infections
Diethylcarbamazine
Ascaris suum
Trichuriasis
Lymphatic Filariasis
Albendazole
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Citations (14)
This randomized, placebo-controlled trial investigated the tolerance, efficacy, and nutritional benefit of combining chemotherapeutic treatment of intestinal helminths and lymphatic filariasis. Children were infected with Ascaris (30.7%), Trichuris (53.4%), and hookworm (9.7%) with 69.9% having more than one of these parasites. A total of 15.8% of the children had Wuchereria bancrofti microfilariae. Children were randomly assigned treatment with placebo, albendazole (ALB), diethylcarbamazine (DEC), or combined therapy. The combination of DEC/ALB reduced microfilarial density compared with placebo, ALB, or DEC (P < or = 0.03). Albendazole and DEC/ALB reduced the prevalence of Ascaris, Trichuris, and hookworm more than placebo or DEC (P < or = 0.03). Among Trichuris-infected children, those receiving ALB and DEC/ALB demonstrated greater gains in weight compared with placebo (P < or = 0.05). Albendazole and DEC/ALB were equally efficacious in treating intestinal helminths and for children with W. bancrofti microfilaremia, DEC/ALB was more effective than DEC, with no increase in severity of adverse reactions.
Albendazole
Diethylcarbamazine
Trichuriasis
Lymphatic Filariasis
Hookworm Infections
Trichuris
Hookworm Infections
Ascaris
Trichuris trichiura
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Citations (61)