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Link to original content: http://pubmed.ncbi.nlm.nih.gov/32289194/
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Meta-Analysis
. 2020 Apr 14;4(4):CD010599.
doi: 10.1002/14651858.CD010599.pub2.

Anthelmintic drugs for treating ascariasis

Lucieni O Conterno  1 , Marilia D Turchi  2 , Ione Corrêa  3 , Ricardo Augusto Monteiro de Barros Almeida  4
Affiliations
Meta-Analysis

Anthelmintic drugs for treating ascariasis

Lucieni O Conterno et al. Cochrane Database Syst Rev. .

Abstract

Background: Ascaris lumbricoides is a common infection, and mainly affects children living in low-income areas. Water and sanitation improvement, health education, and drug treatment may help break the cycle of transmission, and effective drugs will reduce morbidity.

Objectives: To compare the efficacy and safety of anthelmintic drugs (albendazole, mebendazole, ivermectin) for treating people with Ascaris infection.

Search methods: We searched the Cochrane Infectious Disease Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, three other databases, and reference lists of included studies, without language restrictions, up to 4 July 2019.

Selection criteria: Randomized controlled trials (RCT) that compared albendazole, mebendazole, and ivermectin in children and adults with confirmed Ascaris infection.

Data collection and analysis: Two review authors independently assessed studies for inclusion, assessed risk of bias, and extracted data from the included trials. A third review author checked the quality of data extraction. We used the Cochrane 'Risk of bias' assessment tool to determine the risk of bias in included trials. We used risk ratios (RRs) with 95% confidence intervals (CIs) to compare dichotomous outcomes in treatment and control groups. We used the fixed-effect model for studies with low heterogeneity and the random-effects model for studies with moderate to high heterogeneity. We assessed the certainty of the evidence using the GRADE approach. We used the control rate average to provide illustrative cure rates in the comparison groups.

Main results: We included 30 parallel-group RCTs, which enrolled 6442 participants from 17 countries across Africa, Asia, Central America and the Caribbean, and South America. Participants were from 28 days to 82 years of age, recruited from school, communities, and health facilities. Twenty studies were funded or co-funded by manufacturers, while 10 studies were independent of manufacturer funding. Twenty-two trials had a high risk of bias for one or two domains (blinding, incomplete outcome data, selective reporting). Single dose of albendazole (four trials), mebendazole (three trials) or ivermectin (one trial) was compared to placebo. Parasitological cure at 14 to 60 days was high in all the studies (illustrative cure of 93.0% in the anthelmintic group and 16.1% in the placebo group; RR 6.29, 95% CI 3.91 to 10.12; 8 trials, 1578 participants; moderate-certainty evidence). Single dose of albendazole is as effective as multiple doses of albendazole (illustrative cure of 93.2% with single dose, 94.3% with multiple doses; RR 0.98, 95% CI 0.92 to 1.05; 3 trials, 307 participants; high-certainty evidence); or as single dose of mebendazole (illustrative cure of 98.0% with albendazole, 96.9% with mebendazole; RR 1.01, 95% CI 1.00 to 1.02; 6 trials, 2131 participants; high-certainty evidence). Studies did not detect a difference between a single dose of albendazole and a single dose of ivermectin (cure rates of 87.8% with albendazole, 90.2% with ivermectin; RR 0.99, 95% CI 0.91 to 1.08; 3 trials, 519 participants; moderate-certainty evidence). Across all the studies, failure after single dose of albendazole ranged from 0.0% to 30.3%, mebendazole from 0.0% to 22.2%, and ivermectin from 0.0% to 21.6%. The egg reduction rate (ERR) measured up to 60 days after the treatment was high in all treated groups, regardless of the anthelmintic used (range 96% to 100%). It was not possible to evaluate parasitological cure by classes of infection intensity. No included trials reported complication or serious adverse events. Other adverse events were apparently similar among the compared anthelmintic groups (moderate- to low-certainty evidence). The most commonly reported other adverse events were nausea, vomiting, abdominal pain, diarrhoea, headache, and fever.

Authors' conclusions: Single-dose of albendazole, mebendazole, and ivermectin all appeared effective against Ascaris lumbricoides infection, yielding high parasitological cure and large reductions in eggs excreted, with no differences detected between them. The drugs appear to be safe to treat children and adults with confirmed Ascaris infection. There is little to choose between drugs and regimens in terms of cure or adverse events.

PubMed Disclaimer

Conflict of interest statement

LOC has no known conflicts of interest.

MDT has no known conflicts of interest.

IC has no known conflicts of interest.

RAMBA has no known conflicts of interest.

Figures

1
1
Logic diagram of relationship between anthelmintic use and expected outcomes.
2
2
Study flow diagram.
3
3
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study.
1.1
1.1. Analysis
Comparison 1 Any anthelmintic drug single dose versus placebo, Outcome 1 Parasitological cure by time of follow‐up.
2.1
2.1. Analysis
Comparison 2 Albendazole 400 mg single dose versus albendazole 400 mg multiple doses, Outcome 1 Parasitological cure (up to 60 days of follow‐up).
3.1
3.1. Analysis
Comparison 3 Albendazole 400 mg single dose versus mebendazole 500 mg single dose, Outcome 1 Parasitological cure by region.
4.1
4.1. Analysis
Comparison 4 Albendazole 400 mg single dose versus ivermectin 100–400 μg/kg single dose, Outcome 1 Parasitological cure.
5.1
5.1. Analysis
Comparison 5 Albendazole single dose versus mebendazole multiple doses, Outcome 1 Parasitological cure.
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Gyorkos 2013a {published data only}
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Jancloes 1979 {published data only}
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Kale 1982 {published data only}
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Kirwan 2009 {published data only}
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Kirwan 2010 {published data only}
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Tankhiwale 1989 {published data only}
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References to ongoing studies

NCT02636803 {unpublished data only}
    1. NCT02636803. Study of the efficacy of oxfendazole compared to albendazole in the treatment of Trichuris trichiura infection in adults. clinicaltrials.gov/ct2/show/NCT02636803 (first received 22 December 2015).
TCTR20190111001 {unpublished data only}
    1. Sanprasert V. Assessment of efficacy of anthelmintic drugs against soil‐transmitted helminths in Thailand. www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=f... (first received 10 January 2019).

Additional references

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