title: Low efficacy of single-dose albendazole and mebendazole against hookworm and effect on concomitant helminth infection in Lao PDR.
abstract: BACKGROUND
  Albendazole and mebendazole are increasingly deployed for preventive chemotherapy targeting soil-transmitted helminth (STH) infections. We assessed the efficacy of single oral doses of albendazole (400 mg) and mebendazole (500 mg) for the treatment of hookworm infection in school-aged children in Lao PDR. Since Opisthorchis viverrini is co-endemic in our study setting, the effect of the two drugs could also be determined against this liver fluke.
  
  
  METHODS
  We conducted a randomized, open-label, two-arm trial. In total, 200 children infected with hookworm (determined by quadruplicate Kato-Katz thick smears derived from two stool samples) were randomly assigned to albendazole (n=100) and mebendazole (n=100). Cure rate (CR; percentage of children who became egg-negative after treatment), and egg reduction rate (ERR; reduction in the geometric mean fecal egg count at treatment follow-up compared to baseline) at 21-23 days posttreatment were used as primary outcome measures. Adverse events were monitored 3 hours post treatment.
  
  
  RESULTS
  Single-dose albendazole and mebendazole resulted in CRs of 36.0% and 17.6% (odds ratio: 0.4; 95% confidence interval: 0.2-0.8; P=0.01), and ERRs of 86.7% and 76.3%, respectively. In children co-infected with O. viverrini, albendazole and mebendazole showed low CRs (33.3% and 24.2%, respectively) and moderate ERRs (82.1% and 78.2%, respectively).
  
  
  CONCLUSIONS
  Both albendazole and mebendazole showed disappointing CRs against hookworm, but albendazole cured infection and reduced intensity of infection with a higher efficacy than mebendazole. Single-dose administrations showed an effect against O. viverrini, and hence it will be interesting to monitor potential ancillary benefits of a preventive chemotherapy strategy that targets STHs in areas where opisthorchiasis is co-endemic.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN29126001.
authors.affiliation: National Institute of Public Health, Ministry of Health, Vientiane, Lao People's Democratic Republic.
authors.forename: Phonepasong Ayé
authors.initials: PA
authors.lastname: Soukhathammavong
authors.forename: Somphou
authors.initials: S
authors.lastname: Sayasone
authors.forename: Khampheng
authors.initials: K
authors.lastname: Phongluxa
authors.forename: Vilavanh
authors.initials: V
authors.lastname: Xayaseng
authors.forename: Jürg
authors.initials: J
authors.lastname: Utzinger
authors.forename: Penelope
authors.initials: P
authors.lastname: Vounatsou
authors.forename: Christoph
authors.initials: C
authors.lastname: Hatz
authors.forename: Kongsap
authors.initials: K
authors.lastname: Akkhavong
authors.forename: Jennifer
authors.initials: J
authors.lastname: Keiser
authors.forename: Peter
authors.initials: P
authors.lastname: Odermatt
mesh_terms: D015766:Albendazole / Q000008:administration & dosage* / Q000009:adverse effects; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D005243:Feces / Q000469:parasitology; D005260:Female; D006725:Hookworm Infections / Q000188:drug therapy*; D006801:Humans; D007812:Laos; D008297:Male; D008463:Mebendazole / Q000008:administration & dosage* / Q000009:adverse effects; D009889:Opisthorchiasis / Q000188:drug therapy; D010270:Parasite Egg Count; D016896:Treatment Outcome
chemical_list: D000871:Anthelmintics; D008463:Mebendazole; D015766:Albendazole