title: Assessment of anthelmintic efficacy of mebendazole in school children in six countries where soil-transmitted helminths are endemic.
abstract: BACKGROUND
  Robust reference values for fecal egg count reduction (FECR) rates of the most widely used anthelmintic drugs in preventive chemotherapy (PC) programs for controlling soil-transmitted helminths (STHs; Ascaris lumbricoides, Trichuris trichiura, and hookworm) are still lacking. However, they are urgently needed to ensure detection of reduced efficacies that are predicted to occur due to growing drug pressure. Here, using a standardized methodology, we assessed the FECR rate of a single oral dose of mebendazole (MEB; 500 mg) against STHs in six trials in school children in different locations around the world. Our results are compared with those previously obtained for similarly conducted trials of a single oral dose of albendazole (ALB; 400 mg).
  
  
  METHODS
  The efficacy of MEB, as assessed by FECR, was determined in six trials involving 5,830 school children in Brazil, Cambodia, Cameroon, Ethiopia, United Republic of Tanzania, and Vietnam. The efficacy of MEB was compared to that of ALB as previously assessed in 8,841 school children in India and all the above-mentioned study sites, using identical methodologies.
  
  
  RESULTS
  The estimated FECR rate [95% confidence interval] of MEB was highest for A. lumbricoides (97.6% [95.8; 99.5]), followed by hookworm (79.6% [71.0; 88.3]). For T. trichiura, the estimated FECR rate was 63.1% [51.6; 74.6]. Compared to MEB, ALB was significantly more efficacious against hookworm (96.2% [91.1; 100], p<0.001) and only marginally, although significantly, better against A. lumbricoides infections (99.9% [99.0; 100], p = 0.012), but equally efficacious for T. trichiura infections (64.5% [44.4; 84.7], p = 0.906).
  
  
  CONCLUSIONS
  A minimum FECR rate of 95% for A. lumbricoides, 70% for hookworm, and 50% for T. trichiura is expected in MEB-dependent PC programs. Lower FECR results may indicate the development of potential drug resistance.
authors.affiliation: Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium.
authors.forename: Bruno
authors.initials: B
authors.lastname: Levecke
authors.affiliation: Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Antonio
authors.initials: A
authors.lastname: Montresor
authors.affiliation: Fondazione Ivo de Carneri, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Albonico
authors.affiliation: Public Health Laboratory-Ivo de Carneri, Chake Chake, United Republic of Tanzania.
authors.forename: Shaali M
authors.initials: SM
authors.lastname: Ame
authors.affiliation: School of Life Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Jerzy M
authors.initials: JM
authors.lastname: Behnke
authors.affiliation: Microbiology, Immunology, and Tropical Medicine, George Washington University Medical Center, Washington, D.C., United States of America.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Bethony
authors.affiliation: Centre for Schistosomiasis and Parasitology, University of Yaoundé I, Yaoundé, Cameroon.
authors.forename: Calvine D
authors.initials: CD
authors.lastname: Noumedem
authors.affiliation: Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Dirk
authors.initials: D
authors.lastname: Engels
authors.affiliation: Clinical Laboratory, Pasteur Institute, Phnom Penh, Cambodia.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guillard
authors.affiliation: Division of Animal, Food and Health Sciences, Commonwealth Scientific and Industrial Research Organisation, St. Lucia, Australia.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Kotze
authors.affiliation: Instituto de Investigaciones en Enfermedades Tropicales, Universidad Nacional de Salta/CONICET, Oran, Argentina.
authors.forename: Alejandro J
authors.initials: AJ
authors.lastname: Krolewiecki
authors.affiliation: Queensland Institute for Medical Research, University of Queensland, Brisbane, Australia.
authors.forename: James S
authors.initials: JS
authors.lastname: McCarthy
authors.affiliation: Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.
authors.forename: Zeleke
authors.initials: Z
authors.lastname: Mekonnen
authors.affiliation: Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil.
authors.forename: Maria V
authors.initials: MV
authors.lastname: Periago
authors.affiliation: Clinical Laboratory, Pasteur Institute, Phnom Penh, Cambodia.
authors.forename: Hem
authors.initials: H
authors.lastname: Sopheak
authors.affiliation: Centre for Schistosomiasis and Parasitology, University of Yaoundé I, Yaoundé, Cameroon.
authors.forename: Louis-Albert
authors.initials: LA
authors.lastname: Tchuem-Tchuenté
authors.affiliation: Department of Parasitology, National Institute of Malariology, Parasitology and Entomology, Ha Noi, Vietnam.
authors.forename: Tran Thanh
authors.initials: TT
authors.lastname: Duong
authors.affiliation: Department of Parasitology, National Institute of Malariology, Parasitology and Entomology, Ha Noi, Vietnam.
authors.forename: Nguyen Thu
authors.initials: NT
authors.lastname: Huong
authors.affiliation: Department of Medical Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Zeynudin
authors.affiliation: Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium.
authors.forename: Jozef
authors.initials: J
authors.lastname: Vercruysse
mesh_terms: D000293:Adolescent; D015766:Albendazole / Q000494:pharmacology / Q000627:therapeutic use; D000818:Animals; D000871:Anthelmintics / Q000494:pharmacology* / Q000627:therapeutic use; D001938:Brazil; D002160:Cambodia; D002163:Cameroon; D002648:Child; D002675:Child, Preschool; D019353:Endemic Diseases / Q000517:prevention & control; D005002:Ethiopia; D005243:Feces / Q000469:parasitology; D005260:Female; D006373:Helminthiasis / Q000188:drug therapy* / Q000517:prevention & control; D006376:Helminths / Q000187:drug effects*; D006801:Humans; D008297:Male; D008463:Mebendazole / Q000494:pharmacology* / Q000627:therapeutic use; D010270:Parasite Egg Count; D012987:Soil / Q000469:parasitology; D013636:Tanzania; D016896:Treatment Outcome; D014744:Vietnam
chemical_list: D000871:Anthelmintics; D012987:Soil; D008463:Mebendazole; D015766:Albendazole