Low Efficacy of Single-Dose Albendazole and Mebendazole against Hookworm and Effect on Concomitant Helminth Infection in Lao PDR
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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.
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Ascaris lumbricoides is the most highly susceptible parasite species to albendazole and mebendazole among intestinal nematodes infecting humans.
“Among various species of intestinal nematodes infecting humans, Ascaris lumbricoides is the most highly susceptible parasite species to albendazole and mebendazole [1,8–10,42–44] (Table 1).”
From Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update (2021) · cites this paper as [44]
The Results report cure rates above 90% for A. lumbricoides with both drugs, compared with much lower rates for T. trichiura; the Discussion also reports low cure rates for hookworm. This supports A. lumbricoides as the most susceptible of the nematodes compared in this trial, but not the broader ranking across all intestinal nematodes infecting humans. (LLM, conf=0.82)
Experimental — accuracy not yet measuredMebendazole 500 mg single dose for T. trichiura showed lower efficacies recently: 27.9% CR and 66.0% ERR in 2012, 42.1% CR and 66.0% ERR in 2017, and 44.4% CR and 80.7% ERR in 2017.
“Recently, however, the 500 mg single dose regimen showed lower efficacies, 27.9% CR and 66.0% ERR in 2012 [44] (Table 1), 42.1% CR and 66.0% ERR in 2017 [43], and 44.4% CR and 80.7% ERR in 2017 [42].”
From Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update (2021) · cites this paper as [44]
A study in Lao PDR in 2012 reported only 33.3% CR and 67.0% ERR for albendazole against T. trichiura.
“A study in Lao PDR in 2012 reported only 33.3% CR and 67.0% ERR [44].”
From Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update (2021) · cites this paper as [44]
Mebendazole 500 mg single dose shows poor efficacy for hookworms, with CR 15.0-17.6% and ERR 0-98.0%.
“Mebendazole showed poor efficacy for hookworms if used 500 mg only 1 time. Keiser and Utzinger [10] and Soukhathammavong et al. [44] reported the CRs of 500 mg single dose of mebendazole to be 15.0% and 17.6% and ERR 0–98.0% and 76.3%, respectively.”
From Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update (2021) · cites this paper as [44]
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- Authors
- Soukhathammavong, P. A., Sayasone, S., Phongluxa, K., Xayaseng, V., Utzinger, J., Vounatsou, P., Hatz, C., Akkhavong, K., Keiser, J., & Odermatt, P.
- Affiliations
- Swiss Tropical and Public Health Institute (CH)
- Ministry of Health (LA)
- Corresponding author
- Odermatt, Peter
- ORCID
- Venue
- PLoS Neglected Tropical Diseases
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-01-03
- Volume
- 6
- Issue
- 1
- Pages
- e1417
- ISSN
- 1935-2727 (ISSN-L)
- 1935-2735
- PMC
- PMC3250499
- OpenAlex
- W2016276858
- Cited by
- 147
- References
- 41
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 14 · 2023: 8 · 2022: 7 · 2021: 11 · 2020: 12 · 2019: 12 · 2018: 13 · 2017: 15 · 2016: 13 · 2015: 8 · 2014: 9 · 2013: 9 · 2012: 4
- FWCI
- 7.04
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS neglected tropical diseases (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- edoc (University of Basel) (acceptedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- National Science Foundation
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (114941, 110020)
- Direktion für Entwicklung und Zusammenarbeit
- Topics
- Life Sciences › Immunology and Microbiology › Parasitology › Parasites and Host Interactions
- Health Sciences › Veterinary › Small Animals › Helminth infection and control
- Health Sciences › Medicine › Infectious Diseases › Parasitic Diseases Research and Treatment
- Keywords
- hookworm infection, albendazole, mebendazole, soil-transmitted helminths, Opisthorchis viverrini, opisthorchiasis, cure rate, egg reduction rate, school-aged children, preventive chemotherapy, Laos, adverse events, drug efficacy
- MeSH terms
- Animals, Anthelmintics, Child, Feces, Female, Hookworm Infections, Humans, Laos, Male, Mebendazole, Opisthorchiasis, Parasite Egg Count, Albendazole, Treatment Outcome
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