Infectivology Xagena

Trichuris trichiura infection: treatment with Oxantel pamoate - Albendazole better than standard therapy

Infections with soil-transmitted helminths ( Ascaris lumbricoides, hookworm, and Trichuris trichiura ) are widespread and often occur concomitantly. These parasitic-worm infections are typically treated with Albendazole ( Albenza ) or Mebendazole ( Vermox ), but both drugs show low efficacy against Trichuris trichiura.
Albendazole is the drug of choice against hookworm.

In this double-blind trial conducted on Pemba Island, Tanzania, researchers have randomly assigned children, 6 to 14 years of age, to receive one of four treatments: Oxantel pamoate at a dose of 20 mg per kilogram of body weight, plus 400 mg of Albendazole, administered on consecutive days; Oxantel pamoate at a single dose of 20 mg per kilogram; Albendazole at a single dose of 400 mg; or Mebendazole at a single dose of 500 mg.

The efficacy and safety profile of Oxantel pamoate - Albendazole was assessed when used in the treatment of Trichuris trichiura infection ( primary outcome ) and concomitant soil-transmitted helminth infection ( secondary outcome ).
Efficacy was determined by means of assessment of the cure rate and egg-reduction rate.
Adverse events were assessed four times after treatment.

Complete data were available for 458 children, of whom 450 were infected with Trichuris trichiura, 443 with hookworm, and 293 with Ascaris lumbricoides.

The cure rate of Trichuris trichiura infection was significantly higher with Oxantel pamoate - Albendazole than with Mebendazole ( 31.2% vs 11.8%, P=0.001 ), as was the egg-reduction rate ( 96.0% vs 75.0% ).

The cure rate with Albendazole ( 2.6% ) and the egg-reduction rate with Albendazole ( 45.0% ) were significantly lower than the rates with Mebendazole ( P=0.02 for the comparison of cure rates ).

Oxantel pamoate had low efficacy against hookworm and Ascaris lumbricoides.

Adverse events ( mainly mild ) were reported by 30.9% of all children.

In conclusion, the treatment with Oxantel pamoate - Albendazole resulted in higher cure and egg-reduction rates for Trichuris trichiura infection than the rates with standard therapy. ( Xagena )

Speich B et al, N Engl J Med 2014; 370:610-620