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Evaluation of albendazole, pyrantel, bephenium, pyrantel-praziquantel and pyrantel-bephenium for single-dose mass treatment of necatoriasis.

An effective drug for single-dose mass treatment of necatoriasis was sought by testing three drugs and two drug combinations in Ethiopian immigrants to Israel found to have light infections. The drugs tested sequentially in single-doses were pyrantel pamoate (20 mg kg-1, 81 subjects); bephenium hydroxynaphthoate (2.5-5 g, 65 subjects); combined pyrantel and bephenium (25 subjects); combined pyrantel (20 mg kg-1) and praziquantel (40 mg kg-1) (16 subjects); and albendazole (400 mg, 77 subjects). Follow-up under conditions without likelihood of reinfection was by one stool examination. Cure rates with albendazole, pyrantel-bephenium and pyrantel-praziquantel were 84, 80 and 81% respectively; these rates were significantly higher than the 49% found for bephenium and the 51% for pyrantel (P less than 0.05). Egg reductions in those not cured were pyrantel (22%), bephenium (6%), pyrantel-bephenium (34%), pyrantel-praziquantel (3%) and albendazole (6%). Albendazole was the most promising single drug treatment; unexpected was the high effectiveness of pyrantel-praziquantel in combination.

Adolescent

[Epidemiological study of intestinal helminthiasis in the island of Tortuga (Haiti). I. Prevalence of trichocephalosis, ascaridiasis and necatoriasis studied from elimination of eggs in the stools].

An epidemiological survey is conducted by spot-checks over about 10% of the population of Tortuga Island in order to estimate the prevalence of intestinal helminthiasis in that region of the Republic of Haïti, by researching the presence of eggs in faeces. Population sample is representative of the whole of the island's population excepting the 0-4 years old group whose faeces are difficult to obtain. Faeces are examined through the Kato method, a very simple, quick and remarkably accurate procedure. Trichuriasis and ascariasis, which are transmitted in the area around the house, affect mainly children, but also adults. Women seem to be more often infested than men by Ascaris lumbricoides. Necatoriasis, the farmer's disease, hits primarily young men and elderly women who spend most time in the fields. It is observed in inland villages where people are engaged in agricultural production, with a higher incidence if they are located in a not so sloping zone.

Adolescent

[Evaluation of the effectiveness of thiabendazole, pyrantel and mebendazole in the treatment of necatoriasis in children].

A study was made of 48 patients from the different departments of the Hospital del Niño, DIF, in which hookworm eggs were demonstrated by qualitative coproparasitoscopic study (CPS). During the study, quantitative CPS was practiced on them by Stoll's dilution and the Harada-Mori technique, for the identification of the hookworm larvae. They were divided into three groups: A, B and C (16 patients in each group); the study was single-blind. The effectiveness of the evaluated drugs was based on the disappearance or diminution of hookworms eggs in the CPS (Stoll) practiced 2 weeks after the drug treatment had finished. The work was done with patients parasitized by Necator americanus (verified by the Harada-Mori technique). The A group was given pyrantel pamoate; the B group, thiabendazole and the C group, mebendazole. The results obtained were statistically processed by means of X2 proportions. There was no significant difference between the three groups when a light to moderate necatoriasis was treated; when a massive infection was involved, there was a significant difference and it was found that the best drug was pyrantel pamoate administered at the dose of 20 mg/kg/day/3 days. There were few side effects in the three groups, but they were not sufficient to cause suspension of the treatment. The cheapest drug was thiabendazole.

Adolescent

A comparative trial of oxantel-pyrantel and mebendazole in multiple helminth infection in school children.

In a pilot study in 17 children, oxantel-pyrantel as one single dose of 10 to 20mg/kg of each, gave good results in ascariasis but poor cure rates in both trichuriasis and necatoriasis. However in the latter groups the infection was extremely heavy. In a controlled trial in 51 children, using oxantel-pyrantel at the same dose, but given daily for 3 consecutive days, or mebendazole 100mg twice daily for 3 days, the drugs gave similar response rates. Both gave 100% cure rates, as assessed by the absence of ova by both Beaver and brine-flotation techniques, in Ascaris lumbricoides infection. The percentage cures and egg reduction rates were 66.7 and 94.5 in trichuriasis and 53 and 93.6 in necatoriasis respectively. Those for mebendazole were 52 and 91.2 in trichuriasis and 37.5 and 89.7 in necatoriasis. Oxante-pyrantel treatment was associated with more cures, and a marginally greater reduction in ovum excretion than mebendazole but the differences were not statistically significant. No side-effects were seen with either treatment.

Benzimidazoles

Clinical trials with mebendazole a new broad spectrum anthelmintic.

This paper presents our experience with mebendazole, a new broad-spectrum anthelmintic, in 91 cases with ascariasis, 71 cases with necatoriasis 54 cases with trichuriasis and 10 cases with T. saginata infection. Various dosage schedules were evaluated. In ascariasis, a single dose of 200 mg was effective in totally clearing the infection in 100 per cent cases. In necatoriasis 200 mg twice daily for four days was found to be the most effective dose. With this dose total eradication of the infection was seen in 92 per cent cases. In trichuriasis, 200 mg twice daily for four days totally eradicated the infection in 90 per cent cases. In T. saginata infection, the drug was totally ineffective. The anthelminitic activity of the drug was demonstrated by the recovery of roundworms, hookworms and whipworms from the stools. The drug was well tolerated. No side effects or toxic effects were seen in any of the cases.

Adolescent

[1st clinical therapeutic trial of mebendazole in some cases of helmenthiasis in Cuba].

Due to the difficulties faced in the etiologic approach of trichuriasis as a result of the intolerance, reduced efficacy and toxicity of some drugs a clinical-therapeutic trial of mebendazole was started in 5-64 year-old patients with some form of helmynthiasis as trichuriasis, enterobiasis or necatoriasis. Coproparasitological examinations carried out 15, 30 and 45 days after the ingestion of the drug depicted an excellent cure rate (98% in trichuriasis; 100% in enterobiasis; and 85% in necatoriasis). Very few side-effects were found. This is the first clinical-therapeutic trial of mebendazole in parasitic diseases in our country, and it can be affirmed that results have been very positive and also that they are similar to those obtained by foreign authors.

Adolescent

Necator americanus in the DSN hamster: density-dependent expulsion of adult worms during primary infection.

Neonatal hamsters were exposed to varying doses of Necator americanus larvae and changes in the stability of the resulting worm burdens were monitored over a period of 25 weeks. No change in worm burdens was evident for the first 5 weeks of infection, irrespective of the infection intensity, but the more heavily infected groups subsequently lost worms in a density-dependent manner. Male and female hamsters lost comparable proportions of their established parasite burdens indicating that there was no host sex-linked difference in this respect. By week 15 infections had stabilized and the residual worm burdens, usually a maximum of 30 worms survived for a considerably longer period of time. Initially the percentage of male worms varied from 45% to 50% but as infection progressed male worms comprised a significantly increasing proportion of the total worm burden. By week 25 the percentage of male worms was usually in excess of 60%. The growth of infected animals was not severely affected by N. americanus, even when heavy worm burdens established initially, but a significant effect was detected particularly in week 5, prior to worm loss, when the adult worms would have been feeding on intestinal tissues and causing blood loss for a period of about 2 weeks. The most severe depression in the packed cell volume was also recorded in week 5, indicating that anaemia had been initiated in infected hamsters. Whilst, the regulation of parasite burdens in weeks 5-10 post-infection may have resulted from host immunity, the persistence of the residual worm burdens, the marked density-dependent anaemia and the subtle effect on host weight, all reflected well-documented aspects of chronic human necatoriasis.

Animals

Single dose mebendazole therapy for soil-transmitted nematodes.

Four hundred and fifty subjects were included in a study of the prevalence of soil-transmitted nematodes in Ujung Pandang, South-Sulawesi, Indonesia. Trichuriasis was the most prevalent infection (93.3%), followed by ascariasis (80.2%) and hookworm infection (19.5%). Among 156 subjects who were given 500 mg of mebendazole in a single dose, treatment resulted in cure rates of 93.4%, 77.6%, and 91.1%, and average egg-count reduction rates of 99.0%, 92.8%, and 98.3%, for ascariasis, trichuriasis, and hookworm infections, respectively. Mebendazole appeared to be equally effective against necatoriasis and ancylostomiasis. The drug was well tolerated and almost no side effects were observed. Single dose mebendazole treatment appears to be relatively inexpensive, convenient, and effective in mass treatment for the control of intestinal nematode infections, especially in highly infected communities.

Ascariasis

Mass treatment of intestinal parasites among Ethiopian immigrants.

Intestinal parasites are common among the Ethiopian immigrants to Israel and mass treatment is necessary to prevent local transmission. For this purpose, stool samples obtained from the immigrants in absorption centers were examined. Of 5,412 samples obtained, 4,399 (81.3%) were positive: 2,644 (54.2%) for Necator americanus, 2,273 (46.6%) for Schistosoma mansoni, 990 (20.3%) for Ascaris lumbricoides, 1,040 (21.3%) for Hymenolepsis nana, 940 (19.2%) for Trichuris trichiura, 219 (4.5%) for Strongyloides stercoralis, 17 (0.4%) for Fasciola hepatica, 551 (11.3%) for Giardia lamblia, and 499 (9.2%) for Entamoeba histolytica. The cure rate for necatoriasis by treatment with 400 mg of albendazole was 84.4% (better than with other drugs), either alone or in combination (pyrantel with bephenium or pyrantel with praziquantel, or praziquantel with albendazole). Albendazole, 400 mg for 3 days, cured 92% of the cases of S. stercoralis infection. Praziquantel, 40 mg/kg body weight, in a single dose was effective in 89.7% of cases of S. mansoni, and 60% of cases of H. nana, although a 100% cure rate for H. nana was achieved with praziquantel at a dose of 20 mg/kg per day for 2 days. Two persons infected with F. hepatica were cured by 40 mg/kg praziquantel for 7 days. Tinidazole, 2 g in a single dose, cured 100% of persons infected with G. lamblia, while 60% of persons infected with E. histolytica were cured when treated with 2 g tinidazole for 3 days. Mass treatment of all the immigrants with 400 mg albendazole and 40 mg/kg praziquantel concomitantly resulted in a cure rate of 84.4% of all intestinal worms.

Adolescent

Necator americanus in the mouse: histopathological changes associated with the passage of larvae through the lungs of mice exposed to primary and secondary infection.

The mouse/Necator americanus model was studied to assess the histopathological changes that occur in the lungs following primary and secondary exposure to infective larvae. Groups of BALB/c mice were infected percutaneously and killed on various days post infection. Parasite numbers were counted, the bronchoalveolar leukocyte response was quantified and histological sections of lung material were examined for evidence of host protective inflammatory reactions. An increase in the inflammatory infiltration was observed between days 5 and 9 in both primary and secondary infections but was considerably more intense in re-infected animals. This involved a marked change in the character of the infiltrate, particularly in the number of eosinophils that were recovered in lavage fluid. More worms were trapped in the lungs of challenged mice, as assessed through their inability to escape from lung material incubated in vitro. Overall, the results were found to be compatible with the development of acquired resistance to N. americanus and the expression of host protective immunity during the development of challenge-infection larvae in the lungs.

Animals