Source:

Speich
B
,
Ame
SM
,
Ali
SM
, et al
.
Oxantel pamoate-albendazole for Trichuris trichiura infection
.
N Engl J Med.
2014
;
370
(
7
):
610
620
; doi:
https://doi.org/10.1056/NEJMoa1301956

Investigators from Switzerland, Italy, and Tanzania compared the effectiveness of mebendazole, albendazole, and oxantel pamoate in treating Trichuris trichiura and hookworm infection in children from a highly endemic area of Tanzania. Children aged 6 to 14 years old were screened for T trichiura and hookworm using 2 fresh stool samples and underwent a medical examination to exclude concurrent systemic illnesses. Children with T trichiura, hookworm, or both and who did not have systemic illness were eligible. Enrollees were randomized into 1 of 4 treatment groups: oxantel pamoate plus albendazole, oxantel pamoate plus placebo, albendazole plus placebo, or mebendazole plus placebo. Data obtained before treatment included demographics, height, weight, clinical symptoms, and the intensity of infection (light, moderate, or heavy) based upon the number of T trichiura or hookworm eggs per gram of stool.

The primary outcome of the study was to assess the efficacy and safety of a combined treatment of oxantel pamoate with albendazole for T trichiura. The secondary outcome was the effect of this combined therapy on hookworm co-infections. Efficacy was assessed 3 weeks following therapy using 2 stool samples for determination of cure rate (calculated as the percentage of the children who became egg-negative after treatment among those who had had eggs in their stool at baseline) and egg reduction rate. Adverse events were elicited by active questioning.

Of 900 children assessed for eligibility, 480 were randomized (456 with T trichiura-hookworm co-infections) and 458 had complete follow-up data. There were no statistically significant differences in baseline characteristics among children in each of the 4 treatment groups. Compared to mebendazole alone, cure rates for T trichiura were significantly better among participants treated with oxantel pamoate plus albendazole (31.2% vs 11.8%) or with oxantel pamoate alone (26.3% vs 11.8%). However, mebendazole monotherapy was superior to albendazole monotherapy (11.8% vs 2.6%). Children with moderate or heavy infections with T trichiura had either no infection or light infection after treatment with oxantel pamoate plus albendazole. Egg reduction rate after therapy for T trichiura was highest for oxantel pamoate plus albendazole (96.0%) and oxantel pamoate alone (93.2%) compared to mebendazole alone (75.0%) and albendazole alone (45.0%). Cure rates for hookworm infections (443 children) were significantly better for albendazole versus mebendazole (59.8% vs 17.4%) and adding oxantel pamoate did not improve efficacy. Adverse events were comparable between treatment groups and though minor, mainly abdominal cramps, affected 31.0% of the children.

The authors conclude that oxantel pamoate in combination with albendazole could be an effective strategy for controlling soil-transmitted helminthiasis.

Dr Santisteban-Ponce has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

T trichiura (whipworm) and hookworm are soil-transmitted helminths (STH) of public health importance, contributing to intellectual deficiency in...

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