The effectiveness of 3, 5 or 7 days of albendazole for the treatment of Trichuris trichiura infection

A randomized clinical trial was carried out to study the relationship between the duration of albendazole therapy, at 400 mg/day, and its effectiveness in the treatment of Trichuris trichiura infection. The 168 patients were treated for three (N=56), five (N=56) or seven (N=56) consecutive days. Compared with both of the shorter regimens, treatment for 7 days resulted in a significantly higher cure 'rate' and significantly greater reductions in the level of egg excretion. The advantage of using the longer (5- or 7-day) regimens was most apparent among the patients who had heavy infections (at least 1000 Trichuris eggs/g faeces) when treated. It is therefore suggested that albendazole be given for at least 3 days to those with light infections and for 5-7 days to patients with heavy infections.     

Albendazole plus praziquantel versus albendazole alone as a pre-operative treatment in intra-abdominal hydatidosis caused by Echinococcus granulosus

Summary objective  To compare the effects of a combined medication of albendazole (10 mg/kg/day) plus praziquantel (25 mg/kg/day) to those of albendazole alone at different doses (10 and 20 mg/kg/day).
method  The protoscoleces9 viability was studied in a consecutive series of patients affected by intra-abdominal hydatidosis caused by Echinococcus granulosus . In all cases the drugs were given during the month prior to surgery.
results  A significant increase of patients with nonviable protoscoleces was observed in the group treated with the scolicides combination compared to those treated with albendazole alone, both at a dose of 10 mg/kg/day ( P = 0.004) and at a dose of 20 mg/kg/day ( P = 0.03). Albendazole sulphoxide levels in serum and in cyst fluid were higher in patients given the combined therapy than in those who received only albendazole (10 mg/kg/day: P = 0.016; 20 mg/kg/day: P = 0.034). Levels in the cysts were not significantly different probably due to the sample size; nevertheless a lineal relation between the values obtained in serum and inside the cysts could be discerned in the patients treated with the combined medication.
conclusion  Albendazole plus praziquantel is more effective than monotherapy with albendazole in the preoperative treatment of intra-abdominal hydatidosis.     

A comparative trial of levo-praziquantel and praziquantel in the treatment of human Clonorchis sinensis infection]

Seventy patients with clonorchis sinensis infection were divided randomly into two groups and treated with levo-praziquantel and praziquantel in the same dosage of 12.5 mg/kg twice a day for two consecutive days (total dosage of 75 mg/kg). Follow-up stool examination three and six months after treatment showed that the egg negative conversion rates with levo-praziquantel group were 92.86% and 92.59%, while those of praziquantel group were 58.62% and 53.57% respectively. The results showed that levo-praziquantel was significantly superior to praziquantel (P < 0.001). The side reactions in both group were mild and transient.     

Efficacy of albendazole and its combinations with ivermectin or diethylcarbamazine (DEC) in the treatment of Trichuris trichiura infections in Sri Lanka

The efficacy of the drugs currently available for treatment of infection with Trichuris trichiura is low compared with that of the drugs used against roundworm and hookworm. Single-dose combinations of albendazole with ivermectin or of albendazole with diethylcarbamazine (DEC) have recently been seen to produce raid and sustained reductions in Wuchereria bancrofti microfilaraemia. This observation prompted the present study, on the efficacy of these combinations against trichuriasis. The drug regimens tested were albendazole (400 mg) alone, albendazole (400 mg) with ivermectin (200 micrograms/kg), and albendazole (400 mg) with DEC (6 mg/kg). Most (155) of the 176 children (4-14 years of age) who each provided a single, pre-treatment, stool sample were found positive for Trichuris ova. These 155 were each randomly allocated to one of the three treatment groups and checked for infection 3 weeks post-treatment, again by a single stool examination. Single-dose therapy with albendazole plus ivermectin produced a 'cure rate' (79.3%) and an egg-reduction rate (93.8%) which were significantly higher than the corresponding rates produced by albendazole alone or albendazole plus DEC (P < 0.01 for each). The efficacies of albendazole with DEC and of albendazole alone were statistically equivalent. Single-dose treatment with the albendazole-ivermectin combination appears to be highly effective against trichuriasis and could prove valuable for routine use.     

Age-dependency of infection status and serum antibody levels in human whipworm (Trichuris trichiura) infection

This study examines the age-dependency of the relationships between human infection with whipworm (Trichuris trichiura) and parasite-specific antibody level measured by ELISA against an extract of adult worms after preincubation of the sera with Ascaris lumbricoides adult worm extract. The convex age-profile of parasite infection intensity is shown to be mirrored by an age-dependent change in age-class mean levels of IgG (all subclasses except IgG3), IgA, IgM and IgE. Mean antibody levels rise with increasing acquisition of infection in childhood and decline as the intensity of infection falls in adulthood. Immunoblot analysis of selected sera from different age-classes indicates that antigen recognition is similarly dependent on infection intensity. In individual children, antibody levels correlate positively with acquisition of infection, consistent with a simple model of antigen dosage specifying the magnitude of the humoral immune response. In adults, IgG4 correlates positively and IgA negatively with intensity of infection, suggesting involvement of these isotypes in functional roles of immune blockade or effector mechanisms, respectively.     

Mebendazole retention enema for severe Trichuris trichiura (whipworm) infection: a case report

The authors report a case of massive Trichuris trichiura infection, resulting in severe anaemia and congestive cardiac failure in a 9-year-old Iban boy, who was resistant to the usual oral anthelmintic treatment, but promptly responded to mebendazole retention enema. This patient also had an associated Entamoeba histolytica infection.     

我国人群鞭虫感染现状与流行因素分析

目的了解全国(除港澳台外)人群鞭虫感染状况,为制定防治规划提供依据。方法按全国统一方案进行抽样调查,粪检采用改良加藤厚涂片法定量。结果内蒙、辽宁、吉林省未发现鞭虫感染者,其余省(市、区)感染率在0.01%～31.35%之间,人群平均感染率为4.63%。感染者平均克粪虫卵数(EPG)18.99,以轻度感染为主,占89.75%。鞭虫感染受经济状况、居住环境、饮用水源和生产类型等因素影响,感染率女性高于男性,5～15岁组高于其他年龄,少数民族居民高于汉族居民,渔民高于其他职业者(P<0.01)。结论鞭虫感染仍是我国应当关注的重要公共卫生问题,预防控制工作不可松懈。     

Treatment with a single dose of albendazole improves growth of Kenyan schoolchildren with hookworm, Trichuris trichiura, and Ascaris lumbricoides infections

We studied the growth of primary schoolchildren with hookworm (87%), T. trichiura (97%), and A. lumbricoides (49%) who received a single 400 mg dose of albendazole or an identical placebo. Children were allocated at random to placebo (PL, n = 72) or albendazole (A, n = 78) groups, treated, and re-examined 6 months later. The A group gained significantly more than the PL group in weight (1.3 kg), percent weight for age (4.5% age points), percent height for age (0.5% age points), percent weight for height (4.3% age points), percent arm circumference (2.9% age points), and in triceps and subscapular skinfold thicknesses (1.2 mm). The PL group showed significant decreases between exams in percent weight for age, percent height for age, percent weight for height, percent arm circumference for age, and skinfold thicknesses for age. The A group had highly significant increases (P less than 0.0002) in all of these parameters except height for age. From Exam 1 to 2, the A group exhibited decreases (P less than 0.0002) in geometric means eggs per gram of feces (epg): for hookworm, means = 1,183 epg at Exam 1 vs. 136 epg at Exam 2 (67% egg reduction); for T. trichiura, means = 2,857 epg at Exam 1 vs. 1,061 epg at Exam 2 (28% egg reduction); and for A. lumbricoides, means = 86 epg at Exam 1 vs. 2 epg at Exam 2 (91% egg reduction). The PL group had a borderline increase in geometric means hookworm egg count, no significant change in T. trichiura egg count, and a small but significant decrease in A. lumbricoides egg count. Decreases in intensities of all infections were significant predictors of growth improvement. Hookworm egg count entered the equations for all 6 measurements, and A. lumbricoides and T. trichiura entered 4/6 equations. Single dose treatment with albendazole, despite continual exposure to infection, can permit improved growth rates in areas where intestinal helminths and protein-energy malnutrition are highly prevalent.     

A double-blind controlled field trial of doxycycline and albendazole in combination for the treatment of bancroftian filariasis in India

In a placebo controlled field trial, the effects of doxycycline (200 mg/day) for 23 days followed by doxycycline (200 mg/day) in combination with albendazole (ABZ) (400 mg/day) for 7 days on depletion of Wolbachia endobacteria from Wuchereria bancrofti and microfilaricidal activity were studied in 68 patients (34 males and 34 females) from West Bengal, India. The drugs in combination (i.e., doxycycline + ABZ) provided the best efficacy by totally eliminating the circulating microfilaria (mf) (in 42% cases) on day 365 with (99.8%, P < 0.05) suppression even on day 365 post-treatment compared to both exclusive doxycycline (69%, P < 0.05) and ABZ (89%, P < 0.05) groups. Thus, our results have established that a 30-day course of doxycycline in combination with a 7-day course of ABZ is sufficient to ensure long-term reduction in mf level by depleting Wolbachia from worm tissues. Doxycycline combined with ABZ led to a greater reduction in mf density in blood at 4 months (post-treatment) in comparison to doxycycline or ABZ alone. There were significant differences between the three treatments after 12 months (post-treatment). Further, the impact of a 7-day regimen of ABZ was surprisingly good in reducing mf compared to doxycycline-alone group. Adverse reactions were mild. A 30-day course of doxycycline and ABZ in combination is a safe and well-tolerated treatment for lymphatic filariasis with significant activity against microfilaremia.     

A randomized clinical trial comparing single- and multi-dose combination therapy with diethylcarbamazine and albendazole for treatment of bancroftian filariasis

The Global Program for Elimination of Lymphatic Filariasis calls for mass drug administration for endemic populations outside of sub-Saharan Africa with a single dose of diethylcarbamazine (DEC) and albendazole (Alb) annually for 4-6 years. Single-dose DEC/Alb dramatically reduces blood microfilaria (MF) counts, but most treated subjects fail to completely clear MF after a single dose. A more effective regimen might reduce the number of years required for elimination programs. We performed a randomized clinical trial in Egyptian adults with asymptomatic microfilaremia to compare treatment with seven daily doses of oral DEC (6 mg/kg) and Alb (400 mg) with a single dose of the same combination. We also studied the effect of re-treatment with single-dose DEC/Alb 12 months after the first treatment course. Multi-dose DEC/Alb was significantly more effective than single-dose therapy for reducing and clearing microfilaremia (mean reduction in MF/ml relative to pretreatment counts at 12 months, 99.6% versus 85.7%, with complete clearance in 75% versus 23.1%). The two regimens had similar activity against adult filarial worms, as indicated by serial ultrasound assessments. Neither regimen resulted in complete clearance of filarial antigenemia. There was no difference in adverse events, which were mild to moderate. Blood microfilaria and parasite antigen clearance rates increased following re-treatment. Multi-dose DEC/Alb may be a useful option for filariasis elimination programs, especially in the first year (when enthusiasm for mass drug administration and coverage rates are high), to quickly reduce community MF loads and transmission rates.     

Effectiveness of mebendazole in Trichuris trichiura; a report on 2 cases of mild infection

Two admitted patients, a 5-year-old Filipino girl and a 29-year-old Indonesian man, who were diagnosed otherwise were concurrently found to harbour Trichuris trichiura eggs in stoll specimens containing 3,300 and 30 eggs per gram feces (EPG), respectively. A satisfactory response was obtained with administration of mebendazole in the recommended dose of 100 mg twice daily for three consecutive days. Repeated post-treatment fecal examinations revealed 0 EPG. Adverse reaction, either physical or laboratory, due to the anthelmintic was negative. The study indicates that the effectiveness of mebendazole on mild infection with T. trichiura is excellent without any untoward effect.     

Age-dependency of serum isotype responses and antigen recognition in human whipworm (Trichuris trichiura) infection

The present study examines the age-dependency of parasite-specific isotype responses and antigen recognition profiles of individuals within a Trichuris trichiura endemic community, in order to evaluate the significance of serum antibodies as determinants of observed age-related patterns of infection intensity. A high degree of individual heterogeneity is observed in isotype responses to separated T. trichiura antigens by Western blot. Recognition by IgG₁ antibodies exhibits marked age-dependency. The age-profiles of IgG₁ responses to selected antigens of 16–17 kDa and 90 kDa molecular weight reflect the age-related changes in current infection intensity at the population level. Similarly, mean age patterns of IgG₂ responses to a 90 kDa antigen, and mean IgG₄ responses to a 16–17 kDa antigen reflect mean infection levels. IgG₃ responses are negligible, and for methodological reasons, both IgE and IgM specificities are not presented. IgA responses to separated antigens of 16–17 kDa and 90 kDa, exhibit age-profiles which may suggest the development of an IgA-mediated acquired resistance to T. trichiura with age. IgA levels remain elevated throughout early adulthood, when infection intensity levels markedly decrease, supporting the hypothesis that IgA antibodies may be significant in generating the convex nature of the age-infection profile of T. trichiura.