title: Assessment of the anthelmintic efficacy of albendazole in school children in seven countries where soil-transmitted helminths are endemic.
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.
  
  
  RESULTS
  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
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01087099.
authors.affiliation: Department of Virology, Parasitology and Immunology, Ghent University, Faculty of Veterinary Medicine, Merelbeke, Belgium. Jozef.Vercruysse@ugent.be
authors.forename: Jozef
authors.initials: J
authors.lastname: Vercruysse
authors.forename: Jerzy M
authors.initials: JM
authors.lastname: Behnke
authors.forename: Marco
authors.initials: M
authors.lastname: Albonico
authors.forename: Shaali Makame
authors.initials: SM
authors.lastname: Ame
authors.forename: Cécile
authors.initials: C
authors.lastname: Angebault
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Bethony
authors.forename: Dirk
authors.initials: D
authors.lastname: Engels
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guillard
authors.forename: Thi Viet Hoa
authors.initials: TV
authors.lastname: Nguyen
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Kang
authors.forename: Deepthi
authors.initials: D
authors.lastname: Kattula
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Kotze
authors.forename: James S
authors.initials: JS
authors.lastname: McCarthy
authors.forename: Zeleke
authors.initials: Z
authors.lastname: Mekonnen
authors.forename: Antonio
authors.initials: A
authors.lastname: Montresor
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Periago
authors.forename: Laurentine
authors.initials: L
authors.lastname: Sumo
authors.forename: Louis-Albert Tchuem
authors.initials: LA
authors.lastname: Tchuenté
authors.forename: Thi Cam Thach
authors.initials: TC
authors.lastname: Dang
authors.forename: Ahmed
authors.initials: A
authors.lastname: Zeynudin
authors.forename: Bruno
authors.initials: B
authors.lastname: Levecke
mesh_terms: D000293:Adolescent; D015766:Albendazole / Q000008:administration & dosage*; D000722:Ancylostoma / Q000302:isolation & purification; D000724:Ancylostomiasis / Q000188:drug therapy*; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage*; D001196:Ascariasis / Q000188:drug therapy*; D017164:Ascaris lumbricoides / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D004358:Drug Therapy / Q000379:methods / Q000592:standards*; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D008297:Male; D017221:Necator americanus / Q000302:isolation & purification; D010270:Parasite Egg Count; D012574:Schools; D013334:Students; D016896:Treatment Outcome; D014257:Trichuriasis / Q000188:drug therapy*; D014258:Trichuris / Q000302:isolation & purification
chemical_list: D000871:Anthelmintics; D015766:Albendazole