tribendimidine and Ascariasis

A. lumbricoides is the largest of the common nematode parasites of man and has been associated with intestinal pathology, respiratory symptoms and malnutrition in children from endemic areas. Current anthelmintic treatments have proven to be safe. However, a reduced efficacy of single dose drugs has been reported. In veterinary practice, anthelmintic drug resistance is an irreversible problem. Thus, research and development of sensitive tools for early detection of drug resistance as well as new anthelmintic approaches are urgently needed. In this review, we summarized data providing information about current drug therapy against A. lumbricoides and other intestinal helminths, new drugs in experimental trials, future drugs perspectives and the identification of immunogenic parasite molecules that may be suitable vaccine targets. In addition to the WHO recommended drugs (albendazole, mebendazole, levamisole, and pyrantel pamoate), new anthelmintic alternatives such as tribendimidine and Nitazoxanide have proved to be safe and effective against A. lumbricoides and other soil-transmitted helminthiases in human trials. Also, some new drugs for veterinary use, monepantel and cyclooctadepsipeptides (e.g., PF1022A), will probably expand future drug spectrum for human treatments. The development of genomic technology has provided a great amount of available nematode DNA sequences, coupled with new gene function data that may lead to the identification of new drug targets through efficient mining of nematode genomic databases. On the other hand, the identification of nematode antigens involved in different parasite vital functions as well as immunomodulatory molecules in animals and humans may contribute to future studies of new therapeutic approaches.

Topics: Animals; Antinematodal Agents; Ascariasis; Ascaris lumbricoides; Drug Delivery Systems; Host-Parasite Interactions; Humans; Phenylenediamines

Diagnosis of soil-transmitted helminths (STHs) in developing countries is commonly based on microscopic detection of eggs in stool samples, using the Kato-Katz (KK) method, which has a poor sensitivity for detecting light intensity infections. We compared the performance of the KK method and real-time PCR in the framework of a randomized trial, which evaluated four novel treatments against Trichuris trichiura and concomitant STH infections.. Two stool samples obtained from 320 participants were examined at baseline and follow-up with quadruplicate KK and PCR analyses of one of the two samples using "bead-beating" for DNA extraction. At follow-up, 80 samples were negative according to both PCR and KK and 173 were positive with both methods for any of the STHs. Relative to PCR, the calculated sensitivity of KK at follow-up was 83.6%, 43.0% and 53.8% for T. trichiura, for hookworm and for Ascaris lumbricoides, respectively. The sensitivity of PCR compared with KK at this time point was 89.1% for T. trichiura, 72.7% for hookworm and 87.5% for A. lumbricoides. Cure rates (CRs) for T. trichiura and A. lumbricoides were slightly lower with the PCR method. For hookworm CRs with KK were mostly significantly lower, namely 36.7%, 91.1%, 72.2% and 77.8% for moxidectin, moxidectin in combination with tribendimidine, moxidectin in combination with albendazole and albendazole in combination with oxantel pamoate, respectively, whereas with PCR the CRs were 8.3%, 82.6%, 37.1% and 57.1%, respectively.. In conclusion, a single real-time PCR is as sensitive as quadruplicate KK for T. trichiura and A. lumbricoides detection but more sensitive for hookworm, which has an influence on the estimated treatment efficacy. PCR method with DNA extraction using the "bead-beating protocol" should be further promoted in endemic areas and laboratories that can afford the needed equipment. The study is registered at ISRCTN (no. 20398469).

Topics: Adolescent; Albendazole; Ancylostomatoidea; Animals; Anthelmintics; Ascariasis; Ascaris lumbricoides; Child; Diagnostic Tests, Routine; DNA, Helminth; Feces; Female; Hookworm Infections; Humans; Macrolides; Male; Phenylenediamines; Pyrantel Pamoate; Real-Time Polymerase Chain Reaction; Sensitivity and Specificity; Soil; Trichuriasis; Trichuris; Young Adult

Both tribendimidine and mebendazole are broad-spectrum drugs for anti-intestinal nematodes. We aim to assess the efficacy and safety of tribendimidine and mebendazole in patients with co-infection of Clonorchis sinensis and other helminths.. We performed a randomized open-label trial in Qiyang, People's Republic of China. Eligible participants were randomly assigned to one of four groups: (i) a single dose of 400 mg tribendimidine, (ii) 200 mg tribendimidine twice daily, (iii) 75 mg/kg praziquantel divided in four doses within 2 days, and (iv) a single dose of 400 mg mebendazole. Cure rates and egg reduction rates were assessed, and adverse events were monitored after treatments. Uncured patients accepted the second treatment with the same drugs after the first treatment.. 156 patients were eligible for the study. Results from the first treatment showed that the cure rates of single-dose tribendimidine and praziquantel against C. sinensis were 50% and 56.8%, respectively; the single-dose tribendimidine achieved the cure rate of 77.8% in the treatment for hookworm, which was significantly higher than that of praziquantel; Low cure rates were obtained in the treatment of single-dose tribendimidine against Ascaris lumbricoides and Trichuris trichiura (28.6% and 23.1%). Results of the second treatment illustrated the cure rates of tribendimidine and praziquantel against C. sinensis were 78.1% and 75%, respectively. Most adverse events were mild and transient. Adverse events caused by tribendimidine were significantly less than praziquantel.. Single-dose tribendimidine showed similar efficacy against C. sinensis as praziquantel with less adverse events, and achieved significantly higher cure rate in the treatment for hookworm than those of praziquantel and mebendazole. Low cure rates, which were still higher than other drugs, were obtained in the treatment of single-dose tribendimidine against Ascaris lumbricoides and Trichuris trichiura.. Controlled-Trials.com ISRCTN55086560.

Topics: Adult; Animals; Anthelmintics; Ascariasis; Clonorchiasis; Coinfection; Female; Helminthiasis; Humans; Male; Mebendazole; Middle Aged; Phenylenediamines; Praziquantel

To evaluate the efficacy and safety of tribendimidine in treatment of children with hookworm and Ascaris lumbricoides infections.. An open and multi-center clinical trial was conducted in the provinces of Hainan, Sichuan and Guizhou. 899 children aged 4-14 years were enrolled in the study. Hookworm, A. lumbricoides or other helminth infections were diagnosed by improved Kato-Katz method. All the patients were treated orally with tribendimidine enteric coated tablet at a single dose of 200 mg. The efficacy was evaluated by stool examination 3-4 weeks post treatment.. The cure rate and effective rate of the children with hookworm infection were 82.0% (433/528) and 99.2% (524/528), respectively, while in children with A. lumbricoides infection, they were 95.0% (576/639) and 99.8% (637/639), respectively. The efficacy of tribendimidine enteric coated tablet given to the children with Trichuris trichiura infection at a single dose of 200 mg was 36.8% (112/304). The adverse effect induced by tribendimidine, such as dizziness, nausea and vomiting, was light and transient with an adverse effect rate of 1.6% (14/899). No apparent impact was seen on the blood and urine routine examination, hepatic and renal function as well as ECG examination. Conclusion Tribendimidine given at a single dose of 200 mg exhibits lower adverse effect rate and potential efficacy in the treatment of children with hookworm and A. lumbricoides infections.

Topics: Adolescent; Ascariasis; Child; Child, Preschool; China; Double-Blind Method; Female; Hookworm Infections; Humans; Intestinal Diseases, Parasitic; Male; Phenylenediamines; Tablets, Enteric-Coated; Treatment Outcome; Trichuriasis

To study the therapeutic effect and possible adverse effects of tribendimidine enteric coated tablets in the treatment of infections due to hookworms, Ascaris lumbricoides, Trichuris trichiura, Enterobius vermicularis.. According to the standard clinical trial design and protocol, persons infected with hookworms, Ascaris lumbricoides, Trichuris trichiura, or Enterobius vermicularis respectively, were treated with tribendimidine enteric coated tablets in four counties of Guangdong and Jiangsu Provinces, albendazole was used as control.. For hookworm infection, the curative rate (eggs negative in the faeces) were 89.5% (85/95) and 70.6% (60/85) with tribendimidine (400 mg) and albendazole(400 mg) respectively; for Ascaris infection, 97.4% (114/117) and 98.9% (91/92) with tribendimidine(300 mg) and albendazole(400 mg) respectively; for Trichuris infection, 33.3% (25/75) and 56.1% (23/41) with tribendimidine(400 mg/day for 3 days) and albendazole(400 mg/day for 3 days) respectively; for Enterobius infection in children, 74.1% (60/81) and 93.0% (40/43) with tribendimidine(200 mg) and albendazole(200 mg) respectively. No considerable side effect was found.. Tribendimidine is highly active in the treatment of hookworm, Ascaris lumbricoides infections, free of major adverse effect and easy to administer. It is more effective than albendazole for the infection of Necator americanus.

Topics: Adolescent; Adult; Aged; Albendazole; Ancylostomatoidea; Animals; Ascariasis; Ascaris lumbricoides; Child; Double-Blind Method; Enterobiasis; Enterobius; Hookworm Infections; Humans; Intestinal Diseases, Parasitic; Middle Aged; Necator americanus; Nematode Infections; Phenylenediamines; Tablets, Enteric-Coated; Treatment Outcome; Trichuriasis; Young Adult

Soil-transmitted helminths infect 1.5 billion people worldwide. Treatment with anthelminthics is the key intervention but interactions between anthelminthic agents and the gut microbiota have not yet been studied. In this study, the effects of four anthelminthic drugs and combinations (tribendimidine, tribendimidine plus ivermectin, tribendimidine plus oxantel-pamoate, and albendazole plus oxantel-pamoate) on the gut microbiota were assessed. From each hookworm infected adolescent, one stool sample was collected prior to treatment, 24 h post-treatment and 3 weeks post-treatment, and a total of 144 stool samples were analyzed. The gut bacterial composition was analyzed using 16S rRNA gene sequencing. Tribendimidine given alone or together with oxantel-pamoate, and the combination of albendazole and oxantel pamoate were not associated with any major changes in the taxonomic composition of the gut microbiota in this population, at both the short-term post-treatment (24 h) and long-term post-treatment (3 weeks) periods. A high abundance of the bacterial phylum Bacteroidetes was observed following administration of tribendimidine plus ivermectin 24 h after treatment, due predominantly to difference in abundance of the families Prevotellaceae and Candidatus homeothermaceae. This effect is transient and disappears three weeks after treatment. Higher abundance of Bacteroidetes predicts an increase in metabolic pathways involved in the synthesis of B vitamins. This study highlights a strong relationship between tribendimidine and ivermectin administration and the gut microbiota and additional studies assessing the functional aspects as well as potential health-associated outcomes of these interactions are required.

Topics: Adolescent; Albendazole; Anthelmintics; Ascariasis; Bacteria; Bacteroidetes; Biotin; DNA, Bacterial; Drug Therapy, Combination; Feces; Gastrointestinal Microbiome; Hookworm Infections; Humans; Ivermectin; Metabolic Networks and Pathways; Parasite Egg Count; Phenylenediamines; Pyrantel Pamoate; RNA, Ribosomal, 16S; Trichuriasis