tribendimidine and Trichuriasis

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

The recommended anthelmintics show low efficacy in a single-dose regimen against Trichuris trichiura. Moxidectin, a new treatment for river blindness, might complement the drug armamentarium for the treatment and control of soil-transmitted helminthiasis. However, its efficacy against T trichiura has not yet been studied. The aim of the study was to assess the efficacy of moxidectin alone and in co-administrations against T trichiura infection.. A randomised, single-blind, non-inferiority trial was done in two primary schools and one secondary school in Pemba, Tanzania. Adolescents aged 12-18 years who tested positive for T trichiura were randomly assigned (5:5:3:3) with a computer-generated sequence to receive moxidectin (8 mg) plus albendazole (400 mg), albendazole (400 mg) plus oxantel pamoate (25 mg/kg; reference treatment), moxidectin (8 mg) plus tribendimidine (200 mg or 400 mg), or moxidectin (8 mg) alone. Study group assignments were masked from participants and laboratory technicians. The primary outcome was non-inferiority with a 2 percentage point margin for egg reduction rate (ERR) against T trichiura assessed as the relative change in the geometric mean egg counts from baseline to 14-21 days after treatment with the Kato-Katz method, based on the available case population. Cure rates (CR) and tolerability (assessed 3, 24, and 48 h post treatment) were secondary outcomes. The study is registered at ISRCTN (number 20398469) and is closed to accrual.. 701 students were enrolled between April 1, and Aug 7, 2017. Primary outcome data were available for 634 students. We observed ERRs of 98·5% for moxidectin plus albendazole and 99·8% for albendazole plus oxantel pamoate, resulting in an absolute difference of -1·2 percentage points (95% CI -1·8 to -0·8), meeting the non-inferiority margin. 100 (51%) of 197 students receiving moxidectin plus albendazole and 166 (83%) of 200 receiving albendazole plus oxantel pamoate were cured, indicating a difference of 32 percentage points (odds ratio 5·3, 95% CI 3·3 to 8·7). ERRs were 91·6% for moxidectin-tribendimidine and 83·2% for moxidectin. Only mild adverse events (mainly headache and stomach pain) were reported. The largest number of adverse events (126 [20%] of 632 students) was observed 24 h post treatment, with no difference among the individual treatment arms (ranging from 23 [19%] of 118 students treated with moxidectin to 38 [19%] of 199 with moxidectin plus albendazole).. Moxidectin plus albendazole showed non-inferiority to albendazole plus oxantel pamoate in terms of ERR; however, albendazole plus oxantel pamoate showed a considerably higher cure rate. Dose-optimisation studies with moxidectin and moxidectin plus albendazole should be considered since the efficacy of the dose used for the treatment of onchocerciasis (8 mg) in this study might not be optimal for the treatment of T trichiura infections.. Thrasher Foundation.

Topics: Administration, Oral; Adolescent; Albendazole; Animals; Anthelmintics; Child; Drug Therapy, Combination; Female; Humans; Macrolides; Male; Mebendazole; Phenylenediamines; Pyrantel Pamoate; Single-Blind Method; Trichuriasis; Trichuris

The presence of large Trichuris spp. eggs in human faecal samples is occasionally reported. Such eggs have been described as variant Trichuris trichiura or Trichuris vulpis eggs. Within the frame of a randomised controlled trial, faecal samples collected from 115 Bulang individuals from Yunnan, People's Republic of China were subjected to the Kato-Katz technique (fresh stool samples) and the FLOTAC and ether-concentration techniques (sodium acetate-acetic acid-formalin (SAF)-fixed stool samples). Large Trichuris spp. eggs were noted in faecal samples with a prevalence of 6.1% before and 21.7% after anthelminthic drug administration. The observed prevalence of standard-sized T. trichiura eggs was reduced from 93.0% to 87.0% after treatment. Considerably more cases of large Trichuris spp. eggs and slightly more cases with normal-sized T. trichiura eggs were identified by FLOTAC compared to the ether-concentration technique. No large Trichuris spp. eggs were observed on the Kato-Katz thick smears.

Topics: Adolescent; Adult; Albendazole; Animals; Anthelmintics; Child; Child, Preschool; China; Feces; Female; Humans; Male; Parasite Egg Count; Phenylenediamines; Prevalence; Sensitivity and Specificity; Trichuriasis; Trichuris; Young Adult

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

Topics: Albendazole; Humans; Macrolides; Phenylenediamines; Pyrantel Pamoate; Single-Blind Method; Trichuriasis

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