LOW EFFICACY OF MEBENDAZOLE AGAINST HOOKWORM IN VIETNAM: TWO RANDOMIZED CONTROLLED TRIALS
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Vietnam is participating in a global de-worming effort that aims to treat 650 million school children regularly by 2010. The treatment used in Vietnam is single dose oral mebendazole (Phardazone®) 500 mg. We tested the efficacy of single dose mebendazole 500 mg in the therapy of hookworm infection in a randomized double-blind placebo-controlled trial among 271 Vietnamese schoolchildren. The treatment efficacy of single dose mebendazole in children did not differ significantly from placebo, with a reduction in mean eggs per gram of feces relative to placebo of 31% (95% CI -9 to 56%, P = 0.1). In light of these findings we then carried out a similar randomized trial comparing triple dose mebendazole, single dose albendazole, and triple dose albendazole against placebo in 209 adults in the same area. The estimated reduction in mean post-treatment eggs per gram of feces relative to placebo was 63% (95% CI 30–81%) for triple mebendazole, 75% (47–88%) for single albendazole, and 88% (58–97%) for triple albendazole. Our results suggest that single dose oral mebendazole has low efficacy against hookworm infection in Vietnam, and that it should be replaced by albendazole. These findings are of major public health relevance given the opportunity costs of treating entire populations with ineffective therapies. We recommend that efficacy of anti-helminth therapies is pilot tested before implementation of national gut worm control programs.
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Thereafter, low efficacies of mebendazole or albendazole against hookworms were repeatedly reported; for example, in Pemba Island, Zanzibar, Vietnam, and Ghana.
“Thereafter, low efficacies of mebendazole or albendazole against hookworms were repeatedly reported; for example, in Pemba Island, Zanzibar [335,337], Vietnam [338], and Ghana [339].”
From Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update (2021) · cites this paper as [338]
In Vietnam, a single (500 mg) or multiple doses of mebendazole (500 mg daily for 3 days) was found to have disappointing efficacy against hookworm infections in children (CR; 38% in mebendazole single dose group vs 33% in placebo group) and adults (CR; 26% in mebendazole 3-day group vs 35% in placebo group).
“In Vietnam, a single (500 mg) or multiple doses of mebendazole (500 mg daily for 3 days) was found to have disappointing efficacy against hookworm infections in children (CR; 38% in mebendazole single dose group vs 33% in placebo group) and adults (CR; 26% in mebendazole 3-day group vs 35% in placebo group) [338].”
From Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update (2021) · cites this paper as [338]
Drug resistance was also shown in albendazole in adults; CR was 45% in single dose albendazole (400 mg) group and 79% in albendazole 3-day group in comparison with 35% placebo group.
“Drug resistance was also shown in albendazole in adults; CR was 45% in single dose albendazole (400 mg) group and 79% in albendazole 3-day group in comparison with 35% placebo group [338].”
From Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update (2021) · cites this paper as [338]
These findings should provide some concern to the global health community, as the scale-up of mass drug administration for soil-transmitted helminths is now placing similar selection pressures for benzimidazole resistance in human hookworms and reduced efficacies are widely reported.
“Consequently, these findings should provide some concern to the global health community, as the scale-up of mass drug administration for soil-transmitted helminths (STH) is now placing similar selection pressures for benzimidazole resistance in human hookworms and reduced efficacies are widely reported [91–96].”
From Multiple drug resistance in the canine hookworm Ancylostoma caninum: an emerging threat? (2019) · cites this paper as [92]
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References 28 · Cited by 108
- Authors
- FLOHR, C., TUYEN, L. N., LEWIS, S., MINH, T. T., CAMPBELL, J., BRITTON, J., WILLIAMS, H., HIEN, T. T., FARRAR, J., & QUINNELL, R. J.
- Affiliations
- University of Leeds (GB)
- Venue
- The American Journal of Tropical Medicine and Hygiene
- Published
- 2007-04
- Volume
- 76
- Issue
- 4
- Pages
- 732-736
- ISSN
- 0002-9637 (ISSN-L)
- OpenAlex
- W2140628642
- Cited by
- 108
- References
- 28
- Citations by year
- 2024: 5 · 2023: 2 · 2022: 4 · 2021: 6 · 2020: 5 · 2019: 7 · 2018: 7 · 2017: 6 · 2016: 9 · 2015: 4 · 2014: 5 · 2013: 7 · 2012: 10
- FWCI
- 4.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Tropical Medicine and Hygiene (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Funders
- Asthma and Lung UK
- University of Oxford
- University of Leeds
- University of Nottingham
- Directorate for Biological Sciences
- 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, mebendazole, albendazole, anthelmintic efficacy, elementary school students, deworming programs, Vietnam
- MeSH terms
- Adolescent, Adult, Aged, Animals, Anthelmintics, Child, Double-Blind Method, Female, Hookworm Infections, Humans, Male, Mebendazole, Middle Aged, Vietnam, Albendazole
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