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Low Efficacy of Single-Dose Albendazole and Mebendazole against Hookworm and Effect on Concomitant Helminth Infection in Lao PDR
Open accessAbstract
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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“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]
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“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]
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“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]
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“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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Metadata
- 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
- Life Sciences › Immunology and Microbiology › Parasitology › 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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