Efficacy of metronidazole in dracunculiasis. A clinical trial.

In a clinical trial of metronidazole for dracunculiasis (75 cases), the drug was effective in giving symptomatic relief but had no preventive or vermicidal action. It was well tolerated. No difference was observed in the results of two dose schedules (200 mg or 400 mg three times daily for 10 days).     

Efficacy of multiple dose mebendazole against trichuriasis in Thai and Karen patients

Treatment of trichuriasis with mebendazole 500 mg for three days, and 100 mg twice daily for three days, yielded cure rates of 93.9 and 88.9% in Thai patients, while the cure rates in Karen patients were 96.2 and 95.5% respectively. The total number of Thai and Karen trichuriasis patients were 60 and 48, when tested by modified cellophane thick smear Kato-Katz technique. There were no significant differences among the two groups of patients and doses of treatment (p > 0.05).     

甲苯咪唑对旋毛虫幼虫及其寄生肌肉的组织学与组织化学观察

目的　观察甲苯咪唑对旋毛虫幼虫及其寄生的骨骼肌的作用。方法　观察沙鼠感染旋毛虫后的幼虫移行期和成囊期经甲苯咪唑治疗 (即感染后 2 0d、5 0d)幼虫及其寄生肌肉组织的组织学和组织化学的变化。结果　甲苯咪唑治疗后幼虫虫体不完整 ,出现空泡 ,5 0d治疗组囊壁结构明显破坏 ;幼虫SDH、NADH -TR、ATPase活性降低 ,LDH活性增高 ,两治疗组肌肉组织SDH、NADH -TR、ATPase均高于相应对照组 ,而LDH活性低于对照组。结论　甲苯咪唑可以破坏旋毛虫囊包的囊壁 ,损伤虫体 ;可抑制旋毛虫幼虫的有氧代谢 ;治疗后肌肉组织有氧代谢增强 ,而无氧糖酵解减弱。     

Low efficacy of mebendazole against hookworm in Vietnam: two randomized controlled trials

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.     

The relative merits of haemoglobin A1c and fasting plasma glucose as first-line diagnostic tests for diabetes mellitus in non-pregnant subjects

HbA_1c was measured by high-performance ion-exchange chromatography in 401 non-pregnant patients undergoing oral glucose tolerance tests (OGTT). All those with HbA_1c>6.2 % (reference range 3.8–5.5 %) had diabetic OGTT (sensitivity 41 %, specificity 100 %). Although a fasting plasma glucose (FPG) cut-off ≥7.0 mmol l⁻¹, as recommended by the American Diabetes Association (ADA), had greater sensitivity (78 %), false positives (12 %) limited its usefulness, so more diagnostic confidence could be placed in a positive HbA_1c. In agreement with the ADA, we found FPG gave only slightly lower diabetes prevalence than the OGTT, but this masked a significant number of individual discrepancies (false positives and negatives) cancelling out each other. The new ADA category of impaired fasting glucose did not correlate well with impaired glucose tolerance. HbA_1c is insufficiently sensitive as a direct substitute for the OGTT. A third of subjects diabetic on OGTT had normal HbA_1c values, so it cannot exclude diabetes as currently defined, but HbA_1c screening could make sufficient positive diagnoses to reduce our non-pregnant OGTTs by one-fifth. If a ‘risk threshold’ for diabetic complications could be applied to HbA_1c, it could replace the OGTT as a more pragmatic diagnostic/prognostic test. © 1998 John Wiley & Sons, Ltd.     

甲苯达唑在不同介质中的溶解度研究

目的 研究甲苯达唑在几种油相和水相介质中的溶解度,通过观察溶解度的变化情况,为药物生物利用度的提高奠定基础.方法 将甲苯达唑分散于大豆油、甘油三油酸酯以及油酸等9种油相介质中,并以1％西黄耆胶和去离子水作为对照,于25℃或37℃的恒温水浴中以100 r/min的速度机械振荡24 h后离心,取上清液采用高效液相色谱法(HPLC)测定甲苯达唑在上述介质中的浓度.结果 在25℃时甲苯达唑在大豆油、甘油三油酸酯以及油酸中的溶解度分别为(2.1±0.2)μg/ml、(54.1±1 9)μg/ml以及(329.4 +9.7) μg/ml,均高于在去离子水(1.0±0.1) μg/ml和1％西黄芪胶(5.5±0.7) μg/ml的溶解度.当介质温度升高到37℃,甲苯达唑在上述溶剂中的溶解度均随着介质温度的升高而增加,其中在3种油相中的溶解度为(34.1 ± 1.9) ～(900.7±57.1)μg/ml,而在1％西黄耆胶和去离子水中增加到(7.2±0.7)μg/ml和(3.7±1.2)μg/ml.结论 与传统的水相给药介质相比,将甲苯达唑分散于油相溶剂中,可显著增加其溶解度.     

Determination of the minmum effective dosages of praziquantel, albendazole, and mebendazole against Clonorchis sinensis infection in rats

In order to determine the minimum effective dosages of praziquantel, albendazole, and mebendazole against Clonorchis sinensis infection in Sprague-Dawley rats, each rat was infected with 30 metacercariae and treated with one of three drugs. The rats were killed and examined 25 days after praziquantel treatment or 11 days after albendazole or mebendazole treatment. The minimum effective dosages were a single dose of praziquantel 375 mg/kg, albendazole 150 mg/kg, and mebendazole 150 mg/kg. Trials are required to determine whether these dosages are useful in the treatment of human clonorchiasis.     

Studies on taeniasis in Taiwan. V. Field trial on evaluation of therapeutic efficacy of mebendazole and praziquantel against taeniasis

Taeniasis is a major public health problem among the aboriginal populations on Taiwan, and is highly prevalent and wide spread in the mountain areas of 10 Counties. Over 27,000 cases of tapeworm infection are estimated influencing the health and economy in the endemic areas. A treatment of taeniasis with mebendazole and praziquantel followed by a re-treatment with atabrine has been done in the field trial, and confirmed that praziquantel is highly effective agent against tapeworm infection, but mebendazole is not. Based upon experiments reported here praziquantel in a single dose of 150 mg, and 450 mg are highly effective against taeniasis and hymenolepiasis respectively.     

A randomized trial comparing mebendazole and secnidazole for the treatment of giardiasis

To compare the efficacy of the two drugs in the treatment of giardiasis, 146 children (aged 5-15 years) with confirmed Giardia lamblia infection were randomly allotted to treatment with mebendazole (200 mg three times daily for 3 days) or secnidazole (30 mg/kg, in a single dose). Parasitological response to treatment was evaluated in each child by the microscopical examination of faecal samples collected 3, 5 and 7 days after he or she had completed treatment. Although the frequency of cure was higher for secnidazole (79.4%) than for mebendazole (78.1%), the difference was not statistically significant (P > 0.05). Both treatment regimens were well tolerated, with only mild, transient and self-limiting side-effects reported. Mebendazole may be preferable to secnidazole in the treatment of giardiasis cases who have an history of intolerance to 5-nitromidazoles, and where infections with Giardia and soil-transmitted helminths frequently co-occur.     

不同剂量阿苯达唑和甲苯咪唑对土源性线虫感染疗效的随机对照试验

目的观察单倍、三倍剂量阿苯达唑和甲苯咪唑治疗土源性线虫感染的效果。方法采用随机对照试验,对314位调查对象随机分为阿苯达唑(400mg)、甲苯咪唑(500mg)、三倍阿苯达唑(400mg,3d)、三倍甲苯咪唑(500mg,3d)等4组,对各药物组治疗蛔虫、钩虫、鞭虫和绦虫感染的疗效进行观察,计算治愈率和粪样虫卵下降率。结果阿苯达唑治疗钩虫的疗效优于甲苯咪唑,两药单倍剂量对钩虫的治愈率分别为69.1%和31.0%,三倍剂量组治愈率分别为92.0%和54。0%,虫卵下降率单倍剂量组为97.3%和83.6%,三倍剂量组为99.7%和96.4%。控制鞭虫感染,三倍剂量疗效优于单倍剂量。两驱虫药物单倍或三倍剂量对蛔虫感染疗效显著(治愈率在93.0%～96.8%之间,虫卵下降率均大于99.9%)。三倍剂量对绦虫感染的治愈率为100%,而单倍剂量仅为50%。结论治疗钩虫和鞭虫感染,三倍剂量方案可获得较高的治愈率。     

The relative merits of pulsus paradoxus and right ventricular diastolic collapse in the early detection of cardiac tamponade: an experimental echocardiographic study

An inspiratory decline in systolic arterial blood pressure exceeding 10 mm Hg has been used clinically to identify hemodynamically significant pericardial effusions. Recently, the echocardiographic sign of right ventricular diastolic collapse (RVDC) has been shown to occur early in the course of cardiac tamponade in association with a hemodynamically important decline in cardiac output. This study was undertaken to compare the relative merits of pulsus paradoxus and the onset of RVDC in the early detection of cardiac tamponade in an unanesthetized canine preparation. We studied six chronically instrumented, conscious dogs with two-dimensional echocardiography during cardiac tamponade induced by continuous infusion of saline into the pericardial space. We recorded intrapericardial pressure, cardiac output (electromagnetic flowmeter), aortic (catheter-tip transducer) and right atrial blood pressures, heart rate, and respiration. None of the dogs had RVDC when the pericardial space was empty, but all dogs showed RVDC during cardiac tamponade. We found that RVDC was strongly related to all of the cardiac parameters evaluated (intrapericardial pressure, cardiac output, aortic blood pressure, heart rate, and stroke volume) and provided information on each that was independent of that provided by pulsus paradoxus. Furthermore, RVDC appeared to be more strongly related to most cardiac parameters than was pulsus paradoxus and to be more sensitive and specific than pulsus paradoxus in detecting changes in intrapericardial pressure early in cardiac tamponade.     

Levamisole and mebendazole in the treatment of bancroftian infection.

Levamisole and mebendazole, broad spectrum anthelminthic compounds were tested against microfilaria of Wuchereria bancrofti, and the results were compared with similarly treated diethylcarbamazine and untreated group. Levamisole at a dosage of 3 mg/kg daily for 8 days showed marked reduction in both microfilaria rate and microfilaria density and immediately thereafter mf-rate steadily increased almost up to pre-treatment level, the mf-density however showed only marginal increase. Mebendazole at dosage of 6 mg/kg daily for 10 days following 8 days treatment of levamisole also showed marginal increase of mf-rate but no increase of mf-density. Treatment with DEC at a dosage of 6 mg/kg daily for 12 days showed comparatively better results both in respect of reduction in mf-rate and mf-density. The reactions - severity and duration were more among levamisole treated groups as compared to DEC treated group. Thus with the dosages tried, DEC could be considered as a better drug than levamisole and mebendazole. Both the latter compounds had no or very limited effect on the adult worms of W. bancrofti.