title: Comparative efficacy of one versus two doses of praziquantel on cure rate of Schistosoma mansoni infection and re-infection in Mayuge District, Uganda.
abstract: BACKGROUND
  The current recommended control strategy for schistosomiasis is annual treatment using 40 mg/kg of praziquantel. However, praziquantel is only effective on adult worms and giving a second dose may increase its efficacy. We assessed the effect of one versus two doses of praziquantel on cure rate and re-infection with Schistosoma mansoni in a high endemic community along Lake Victoria, Uganda.
  
  
  METHODS
  To investigate the effect of the two regimens, 395 infected people were randomised into two groups; one received a single standard dose of praziquantel (Distocide® 600 mg, Shin Poong Pharmaceuticals, Seoul, Republic of Korea), 40mg/kg body weight, while the other group received a second dose 2 weeks later. Cure rate and infection intensity were assessed 9 weeks after the first treatment using standard parasitological procedures. Re-infection levels were monitored 8 and 24 months after treatment.
  
  
  RESULTS
  Those who received two doses were more likely to be cured (69.7%) compared to those who received a single dose (47.9%) (χ(2) = 18.5, p < 0.001). Geometric mean intensity (GMI) of infection at 9 weeks (eggs per gram of faeces [epg]) was 12.0 epg (CI95: 8.9-16.1) for individuals who received 2 doses and 22.1 epg (CI95: 16.9-28.8) for those in the single dose arm. Eight months after treatment, prevalence of re-infection for individuals in the double dose arm (61.6%, CI95: 50.2-73.1) was not significantly different from that of those in a single dose arm (68.3%, CI95: 59.9-76.8). The difference in GMI of re-infection for individuals in the single dose arm (33.8 epg, CI95: 23.2-49.3) and those in the double dose arm (34.5 epg, CI95: 24.7-48.1) was not significant. Twenty four months after treatment, prevalence of re-infection was not significantly different. The difference in GMI of re-infection for those in the single dose arm (57.5 epg, CI95: 33.9-97.5) and those in the double dose arm (42.2 epg, CI95: 29.9-59.6) was also insignificant.
  
  
  CONCLUSIONS
  Our results suggest that a second dose of praziquantel given 2 weeks after the first dose improves cure rate and reduces S. mansoni infection intensity. However, there is no added advantage on reduction of S. mansoni re-infection by administering two doses of praziquantel. CLINICAL TRIALS.GOV IDENTIFIER: NCT00215267.
authors.affiliation: Vector Control Division, Ministry of Health, Kampala, Uganda. edmuheki@gmail.com
authors.forename: Edridah M
authors.initials: EM
authors.lastname: Tukahebwa
authors.forename: Birgitte J
authors.initials: BJ
authors.lastname: Vennervald
authors.forename: Fred
authors.initials: F
authors.lastname: Nuwaha
authors.forename: Narcis B
authors.initials: NB
authors.lastname: Kabatereine
authors.forename: Pascal
authors.initials: P
authors.lastname: Magnussen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage*; D002648:Child; D004334:Drug Administration Schedule; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011223:Praziquantel / Q000008:administration & dosage*; D015995:Prevalence; D012008:Recurrence; D012550:Schistosoma mansoni / Q000302:isolation & purification; D012555:Schistosomiasis mansoni / Q000188:drug therapy* / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000871:Anthelmintics; D011223:Praziquantel
keywords: Cure rate; Re-infection; Schistosoma mansoni; Uganda