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Assessment of the anthelmintic efficacy of albendazole in school children in seven countries where soil-transmitted helminths are endemic

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Abstract
Background: The three major soil-transmitted helminths (STH) Ascaris lumbricoides, Trichuris trichiura and Necator americanus/Ancylostoma duodenale are among the most widespread parasites worldwide. Despite the global expansion of preventive anthelmintic treatment, standard operating procedures to monitor anthelmintic drug efficacy are lacking. The objective of this study, therefore, was to define the efficacy of a single 400 milligram dose of albendazole (ALB) against these three STH using a standardized protocol. Methodology/Principal Findings: Seven trials were undertaken among school children in Brazil, Cameroon, Cambodia, Ethiopia, India, Tanzania and Vietnam. Efficacy was assessed by the Cure Rate (CR) and the Fecal Egg Count Reduction (FECR) using the McMaster egg counting technique to determine fecal egg counts (FEC). Overall, the highest CRs were observed for A. lumbricoides (98.2%) followed by hookworms (87.8%) and T. trichiura (46.6%). There was considerable variation in the CR for the three parasites across trials (country), by age or the pre-intervention FEC (pre-treatment). The latter is probably the most important as it had a considerable effect on the CR of all three STH. Therapeutic efficacies, as reflected by the FECRs, were very high for A. lumbricoides (99.5%) and hookworms (94.8%) but significantly lower for T. trichiura (50.8%), and were affected to different extents among the 3 species by the pre-intervention FEC counts and trial (country), but not by sex or age. Conclusions/Significance: Our findings suggest that a FECR (based on arithmetic means) of >95% for A. lumbricoides and >90% for hookworms should be the expected minimum in all future surveys, and that therapeutic efficacy below this level following a single dose of ALB should be viewed with concern in light of potential drug resistance. A standard threshold for efficacy against T. trichiura has yet to be established, as a single-dose of ALB is unlikely to be satisfactory for this parasite.
Keywords
ASCARIS, MEBENDAZOLE, NEMATODES, HUMAN HOOKWORM INFECTIONS, ANCYLOSTOMA-DUODENALE, NECATOR-AMERICANUS, VETERINARY IMPORTANCE, SOUTHERN REGION, DRUG-RESISTANCE, PARASITOLOGY

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Chicago
Vercruysse, Jozef, Jerzy M Behnke, Marco Albonico, Shaali Makame Ame, Cécile Angebault, Jeffrey M Bethony, Dirk Engels, et al. 2011. “Assessment of the Anthelmintic Efficacy of Albendazole in School Children in Seven Countries Where Soil-transmitted Helminths Are Endemic.” Plos Neglected Tropical Diseases 5 (3).
APA
Vercruysse, Jozef, Behnke, J. M., Albonico, M., Ame, S. M., Angebault, C., Bethony, J. M., Engels, D., et al. (2011). Assessment of the anthelmintic efficacy of albendazole in school children in seven countries where soil-transmitted helminths are endemic. PLOS NEGLECTED TROPICAL DISEASES, 5(3).
Vancouver
1.
Vercruysse J, Behnke JM, Albonico M, Ame SM, Angebault C, Bethony JM, et al. Assessment of the anthelmintic efficacy of albendazole in school children in seven countries where soil-transmitted helminths are endemic. PLOS NEGLECTED TROPICAL DISEASES. 2011;5(3).
MLA
Vercruysse, Jozef, Jerzy M Behnke, Marco Albonico, et al. “Assessment of the Anthelmintic Efficacy of Albendazole in School Children in Seven Countries Where Soil-transmitted Helminths Are Endemic.” PLOS NEGLECTED TROPICAL DISEASES 5.3 (2011): n. pag. Print.
@article{1227071,
  abstract     = {Background: The three major soil-transmitted helminths (STH) Ascaris lumbricoides, Trichuris trichiura and Necator americanus/Ancylostoma duodenale are among the most widespread parasites worldwide. Despite the global expansion of preventive anthelmintic treatment, standard operating procedures to monitor anthelmintic drug efficacy are lacking. The objective of this study, therefore, was to define the efficacy of a single 400 milligram dose of albendazole (ALB) against these three STH using a standardized protocol.
Methodology/Principal Findings: Seven trials were undertaken among school children in Brazil, Cameroon, Cambodia, Ethiopia, India, Tanzania and Vietnam. Efficacy was assessed by the Cure Rate (CR) and the Fecal Egg Count Reduction (FECR) using the McMaster egg counting technique to determine fecal egg counts (FEC). Overall, the highest CRs were observed for A. lumbricoides (98.2\%) followed by hookworms (87.8\%) and T. trichiura (46.6\%). There was considerable variation in the CR for the three parasites across trials (country), by age or the pre-intervention FEC (pre-treatment). The latter is probably the most important as it had a considerable effect on the CR of all three STH. Therapeutic efficacies, as reflected by the FECRs, were very high for A. lumbricoides (99.5\%) and hookworms (94.8\%) but significantly lower for T. trichiura (50.8\%), and were affected to different extents among the 3 species by the pre-intervention FEC counts and trial (country), but not by sex or age.
Conclusions/Significance: Our findings suggest that a FECR (based on arithmetic means) of {\textrangle}95\% for A. lumbricoides and {\textrangle}90\% for hookworms should be the expected minimum in all future surveys, and that therapeutic efficacy below this level following a single dose of ALB should be viewed with concern in light of potential drug resistance. A standard threshold for efficacy against T. trichiura has yet to be established, as a single-dose of ALB is unlikely to be satisfactory for this parasite.},
  articleno    = {e948},
  author       = {Vercruysse, Jozef and Behnke, Jerzy M and Albonico, Marco and Ame, Shaali Makame and Angebault, C{\'e}cile and Bethony, Jeffrey M and Engels, Dirk and Guillard, Bertrand and Hoa, Nguyen Thi Viet and Kang, Gagandeep and Kattula, Deepthi and Kotze, Andrew C and McCarthy, James S and Mekonnen Kurmane, Zeleke and Montresor, Antonio and Periago, Maria Victoria and Sumo, Laurentine and Tchuent{\'e}, Louis-Albert Tchuem and Thach, Dang Thi Cam and Zeynudin, Ahmed and Levecke, Bruno},
  issn         = {1935-2727},
  journal      = {PLOS NEGLECTED TROPICAL DISEASES},
  keyword      = {ASCARIS,MEBENDAZOLE,NEMATODES,HUMAN HOOKWORM INFECTIONS,ANCYLOSTOMA-DUODENALE,NECATOR-AMERICANUS,VETERINARY IMPORTANCE,SOUTHERN REGION,DRUG-RESISTANCE,PARASITOLOGY},
  language     = {eng},
  number       = {3},
  pages        = {10},
  title        = {Assessment of the anthelmintic efficacy of albendazole in school children in seven countries where soil-transmitted helminths are endemic},
  url          = {http://dx.doi.org/10.1371/journal.pntd.0000948},
  volume       = {5},
  year         = {2011},
}

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