Efficacy of a single dose versus a multiple dose regimen of Mebendazole against hookworm infections among school children: a randomized open-label trial

Abstract

Background: Despite the existence of a population-based control program using single dose albendazole or mebendazole as a preventive chemotherapy, hookworm transmission remains high. It causes a negative impact on the growth and school performance of children. In connection to this preventive chemotherapy, different studies produced conflicting results. This study aimed at evaluating the efficacy of single (500 mg) versus multiple doses (100 mg twice a day during three consecutive days) of mebendazole against hookworm infections among schoolaged children. Methods: This randomized open-label clinical trial took place among school-aged children (6-14 years old) in Burie and Debre Elias towns, Northwest Ethiopia. Using simple randomization, eligible hookworm-positive children were allocated (1:1) to either a single or multiple dose treatment arms. Stool samples were collected and processed using McMaster method at baseline and follow-up period (14-21 days after treatment). Only laboratory technicians were blinded. The cure and egg reduction rates were the primary and secondary therapeutic outcome measures against hookworm infections, respectively. An independent t-test was used to compare group means, and logistic regression was used to calculate odds ratio (OR). P-value < 0.05 at 95% CI was considered statistically significant. Result: One hundred eight children, 54 in each treatment arm had completed baseline data and received allocated treatment. One hundred three children had completed follow-up data records and included for the final efficacy analysis. Cure rate against hookworm was significantly higher in the multiple dose (96.1%) than in the single dose (30.8%) with OR = 55.125; 95% CI: 11.92-254.9; P < 0.001. The egg reduction rate in the multiple dose treatment arm (99.5%) was also significantly higher than in the single dose arm (68.9%) with difference t (101) =5.38; 95% CI 230.95-505.36; P < 0.001. Conclusion: The single dose regimen of mebendazole for the treatment of hookworm infections showed poor cure and egg reduction rates, while the multiple doses revealed satisfactory. Although multiple dose regimen administration is a bit more complex than the single dose, we strongly encourage replacing it with multiple dose regimen during deworming programs in hookworm endemic areas.

Modeling the effect of different drugs and treatment regimen for hookworm on cure and egg reduction rates taking into account diagnostic error

“…Mebendazole administered over 3 days in six dosages of 100 mg each is the most efficacious treatment in terms of both CR and ERR (Table 4). Eshetu et al (2020) reported similar CRs and ERRs [33], as modeled data; however, participants in those included trials were chracterized by slightly higher infection intensities at baseline (1,134 EPG compared to 465 EPG in our case), which were less affected by diagnostic error. The value of 1 for the ERR of aformentioned treatment arm in Table 4 (corresponding to 100%) is a rounded value and therefore reliable.…”

Burden of neglected tropical diseases and access to medicine and diagnostics in Ethiopia: a scoping review

“…Chemotherapy using mebendazole [ 97 , 98 ] and MDA campaigns [ 92 , 99 ] are used to prevent and treat STHs. Chemotherapy against STH is crucial, and its coverage was 71% in Ethiopia [ 97 ].…”

An unusual case of extensive truncal Cutaneous larva migrans from remote area in an Indonesian adult male: A case report

“…11 Eshetu et al reported the efficacy of a single dose versus a multiple-dose regimen of Mebendazole against hookworm infections among school children in a randomised openlabel trial. 22 The study suggested that the singledose regimen of Mebendazole for the treatment of hookworm infections demonstrated poor results and low egg reduction rates, while the multiple doses revealed satisfactory.…”