Comparison of ivermectin and thiabendazole in the treatment of uncomplicated human Strongyloides stercoralis infection

Abstract

Ivermectin is the drug of choice in the treatment of onchocerciasis, and has been proven to be highly effective against Strongyloides stercoralis. This study compares ivermectin's efficacy and safety with that of thiabendazole, an established drug of choice for strongyloidiasis, in 252 confirmed cases of uncomplicated human intestinal strongyloidiasis. Subjects were administered orally with ivermectin (200 µg/kg) in a single dose or thiabendazole, 25 mg/kg, twice daily (50mg/kg/day) for 3 consecutive days. Stools were parasitologically examined 7, 21 and 30 days after treatment. Only 18 of 113 and 22 of 103 ivermectin-and thiabendazole-treated subjects, respectively, had stools positive for larvae 30 days post-treatment. This indicates parasitological cure rates of 84.07% and 78.64% for ivermectin and thiabendazole, respectively. Ivermectin was not significantly more effective than thiabendazole (P < 0.05). There was considerable reduction in parasite output in parasitologically uncured subjects with mean of 81% in ivermectin-treated and 75% in thiabendazole-treated groups, respectively. Clinical adverse reactions were mild and transient in subjects treated with ivermectin, while they varied from mild to severe in those treated with thiabendazole. Single-dose ivermectin provides efficacy comparable with standard, multiple-dose thiabendazole, with a much reduced incidence of adverse effects and consequently better patient compliance.

Effectiveness of one and two doses of ivermectin mass drug administration in reducing the prevalence and intensity of soil-transmitted helminth (STH) infections in Western Province, Solomon Islands: a cluster-randomised, before-after analysis

“… 6 Ivermectin monotherapy has high efficacy against S. stercoralis and A. lumbricoides , moderate efficacy against T. trichiura , and poor efficacy against hookworms. 6 , 10 , 11 , 12 Our findings generally align with previous efficacy trials and cross-sectional studies comparing onchocerciasis-treated to untreated areas, that demonstrated substantial reductions in S. stercoralis prevalence and moderate reductions in T. trichiura prevalence and intensity, associated with one dose of ivermectin MDA. 10 , 11 , 12 , 16 , 17 , 18 The marginal non-significant prevalence reduction for Stronygloides spp.…”

“…Ivermectin is a broad-spectrum antiparasitic drug that has high therapeutic efficacy against S. stercoralis and A. lumbricoides , moderate efficacy against T. trichiura , and poor efficacy against hookworms. 6 , 10 , 11 , 12 The combination of albendazole and ivermectin has excellent efficacy against all species. 6 …”