Oxantel Pamoate Is Effective Against Trichuris trichiura Infection

Neeraj K. Surana, M.D., Ph.D., Dennis L. Kasper, M.D.

Disclosures

AccessMedicine from McGraw-Hill 

More than 1 billion persons worldwide are infected with intestinal helminths. The World Health Organization advocates mass campaigns for the treatment of at-risk populations with the goal of preventing illness and reducing transmission. With regard to intestinal helminths, this preventive chemotherapy has consisted of the administration of either albendazole or mebendazole. However, neither of these agents is very effective at treating trichuriasis.

In a randomized, controlled, double-blind study involving Tanzanian children 6–14 years old, Speich and colleagues (2014) investigated the efficacy of oxantel pamoate plus albendazole versus monotherapy with oxantel pamoate, albendazole, or mebendazole against infection with T. trichiura (primary outcome) and concurrent infection with Ascaris lumbricoides or hookworm (secondary outcome). Of 458 children included in the analysis, 450 were infected with T. trichiura, 443 with hookworm, and 293 with A. lumbricoides. Cure rates for T. trichiura infection were higher with oxantel pamoate–albendazole combination therapy [31.2%; 95% confidence interval (CI), 22.5­–40.0] than with either mebendazole monotherapy (11.8%; 95% CI, 5.7–17.9) or albendazole monotherapy (2.6%; 95% CI, 0.0–5.6); the cure rate for treatment with oxantel pamoate by itself (26.3%; 95% CI, 18.1–34.5) was not significantly different from that for combination therapy. The egg reduction rate was similarly higher with combination therapy (96.0%; 95% CI, 93.5–97.6) than with mebendazole (75.0%; 95% CI, 64.2–82.0) or albendazole (45.0%; 95% CI, 32.0–56.4) alone. Notably, the addition of oxantel pamoate to albendazole did not negatively affect the efficacy of therapy for either hookworm or A. lumbricoides. Overall, 30.9% of children experienced an adverse event, but virtually all of these events were mild.

Perspective: This study demonstrates that oxantel pamoate is more effective than other drugs at treating and reducing the infectious burden of T. trichiura without negatively affecting the efficacy of albendazole against hookworm and ascariasis. As noted in an accompanying editorial by Savioli (2014), this study highlights the need for more research on the utility of anthelmintic combinations. While the oxantel pamoate–albendazole combination has a higher cure rate for T. trichiura infection than does monotherapy with albendazole or mebendazole, this rate is still a somewhat paltry 31%. More effective anthelmintic agents are needed, and this study underscores the notion that combination therapy may ultimately provide a reasonable approach for mass drug administration campaigns.

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