Article thumbnail

Efficacy and Safety of Nitazoxanide, Albendazole, and Nitazoxanide-Albendazole against Trichuris trichiura Infection: A Randomized Controlled Trial

By Benjamin Speich, Shaali M. Ame, Said M. Ali, Rainer Alles, Jan Hattendorf, Jürg Utzinger, Marco Albonico and Jennifer Keiser

Abstract

More than 5 billion people are at risk of infection with one of the three most common intestinal worms, the roundworm Ascaris lumbricoides, the whipworm Trichuris trichiura, and two different kinds of hookworms. The global strategy to control these intestinal worm infections is through the regular administration of deworming drugs to school-aged children (albendazole, 400 mg; mebendazole, 500 mg). However, especially against T. trichiura, a low treatment response is observed with single doses of both drugs. We tested the antiprotozoal drug nitazoxanide, which had shown promising trichuricidal properties in in vitro experiments. A randomized controlled trial was carried out on the island of Pemba in Tanzania. Four treatment arms were included: (i) single albendazole (400 mg), (ii) single nitazoxanide (1,000 mg), (iii) nitazoxanide-albendazole combination (1,000 mg–400 mg) with each drug given separately on two consecutive days, and (iv) placebo. Children were asked for adverse events at several time points after treatment. Nitazoxanide showed no ability to cure T. trichiura-infected children and caused significantly more mild adverse events than placebo. Albendazole and the nitazoxanide-albendazole combination showed only a minimal effect against T. trichiura. Our results emphasize the urgent need to develop new, safe, and effective anthelmintic drugs against T. trichiura

Topics: Research Article
Publisher: Public Library of Science
OAI identifier: oai:pubmedcentral.nih.gov:3367984
Provided by: PubMed Central

Suggested articles

Citations

  1. (2010). 2nd WHO model list of essential medicines for children
  2. (1994). A randomized controlled trial comparing mebendazole and albendazole against Ascaris, Trichuris and hookworm infections.
  3. (1972). A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev Inst Med Trop Sa ˜o Paulo
  4. (2009). A single FLOTAC is more sensitive than triplicate Kato-Katz for the diagnosis of lowintensity soil-transmitted helminth infections. Trans R Soc Trop Med Hyg
  5. (2010). Albendazole and mebendazole administered alone or in combination with ivermectin against Trichuris trichiura: a randomized controlled trial.
  6. (2008). Cochane Statistical Methods Group: chapter 16: special topics in statistics. Available: http://hiv.cochrane.org/sites/ hiv.cochrane.org/files/uploads/Ch16_Specialstatistics.pdf. Accessed
  7. (2002). Comparative clinical studies of nitazoxanide, albendazole and praziquantel in the treatment of ascariasis, trichuriasis and hymenolepiasis in children from Peru. Trans R Soc Trop Med Hyg 96:
  8. (2010). Comparing diagnostic accuracy of Kato-Katz, Koga agar plate, etherconcentration, and FLOTAC for Schistosoma mansoni and soil-transmitted helminths.
  9. (1999). Control strategies for human intestinal nematode infections.
  10. (2011). Diagnostic accuracy of Kato-Katz and FLOTAC for assessing anthelmintic drug efficacy.
  11. (2008). Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis.
  12. (2003). Epidemiology and control of intestinal parasites with nitazoxanide in children in Mexico.
  13. (1968). Evaluation of Kato thick-smear technique for quantitative diagnosis of helminth infections.
  14. (2002). Evaluation of the efficacy of pyrantel-oxantel for the treatment of soil-transmitted nematode infections.
  15. (2012). Exploration of novel in vitro assays to study drugs against Trichuris spp.
  16. (2003). Farre ´M ,B a n ˜os JE
  17. (2008). FLOTAC: a new sensitive technique for the diagnosis of hookworm infections in humans.
  18. (2010). FLOTAC: new multivalent techniques for qualitative and quantitative copromicroscopic diagnosis of parasites in animals and humans.
  19. (1997). Geyne Cruz A
  20. (1998). Guidelines for the evaluation of soil-transmitted helminthiasis and schistosomiasis at community level: a guide for managers and control programs. Geneva: World Health Organization,
  21. (1988). Hookworm control.
  22. (2003). Human gastrointestinal helminth infections: are they now neglected diseases?
  23. (2006). Incorporating a rapid-impact package for neglected tropical diseases with programs for HIV/AIDS, tuberculosis, and malaria.
  24. (1975). New derivative of 2-benzamido-5-nitrothiols.
  25. (1998). Nitazoxanide in the treatment of patients with intestinal protozoan and helminthic infections: a report on 546 patients in Egypt.
  26. (2006). Nitazoxanide, a broad-spectrum thiazolide anti-infective agent for the treatment of gastrointestinal infections.
  27. (2012). Nitazoxanide: in vitro and in vivo drug effects against Trichuris muris and Ancylostoma ceylanicum, alone or in combination.
  28. (1997). Parasitic infections in Pemba Island school children.
  29. (2007). Recent progress in integrated neglected tropical disease control.
  30. (1991). Response of pre-adult and adult stages of Trichuris muris to common anthelmintics in mice.
  31. (2007). Simultaneous detection and quantification of Ancylostoma duodenale, Necator americanus,a n dOesophagostomum bifurcum in fecal samples using multiplex realtime PCR.
  32. (2006). Soiltransmitted helminth infections: ascariasis, trichuriasis, and hookworm.
  33. (2010). The drugs we have and the drugs we need against major helminth infections.
  34. (1997). The global burden of intestinal nematode infections–fifty years on.
  35. (2012). The global limits and population at risk of soiltransmitted helminth infections in
  36. (2012). The impact of baseline faecal egg counts on the efficacy of single-dose albendazole against Trichuris trichiura.
  37. (2003). The influence of sampling effort and the performance of the Kato-Katz technique in diagnosing Schistosoma mansoni and hookworm co-infections in rural Co ˆte d’Ivoire.
  38. (2002). Treatment of intestinal parasitic infections: a review of nitazoxanide.
  39. (1982). Treatment of Trichuris trichiura infection with a single dose of oxantel pamoate.

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.