Treatment of Intestinal Helminthiasis

8/18/2019 Treatment of Intestinal Helminthiasis

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Treatment of intestinalhelminthiasis:

mebendazole only or

mebendazole-pyrantel pamoate?

Oleh : Jajang Badrujaman

Pembimbing : dr. Aspri Sulanto, Sp.A, M.Kes


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Intestinal helminthiasis remains a public healthproblem, especiall in tropical and subtropicalde!eloping countries.

"his disease causes high morbidit and

contributes to malnutrition, !itamin A de#cienc,and anemia, and has a negati!e impact ongeneral health and children$s de!elopment.

the pre!alence o% intestinal helminthiasis in

Indonesia &as still high &ith ascariasis '()*+)-,trichuriasis ')*+/-, and hoo0&orm in%ection'1)2/+-.

Background


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One o% the most %re3uentl used anthelminticsis a single dose prantel pamoate 4) mg50g%ollo&ed b mebenda6ole 4)) mg t&ice dail%or 1 consecuti!e das.

"his method is neither practical norcon!enient especiall %or mass treatment.Ideall, anthelmintics should satis% the needso% the majorit o% patients, including simple

regimen, eas to administer, lo& cost, minimalside e7ect, high therapeutic e7ect, ande7ecti!e to all parasite stadium.

Background


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8ecentl, a single dose /)) mgmebenda6ole is used an alternati!etreatment. 9o&e!er, stud on thee7ecti!eness o% t&o or more anthelmintics%or intestinal helminthiasis in masstreatment is still rare, especiall %or multipleor mied helminthiasis. "here%ore, this

stud aimed to in!estigate the e7ecti!enesso% t&o di7erent antihelmintics %or multiplehelminthiasis in%ection.

Background


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"his randomi6ed double blind clinical trial &as conductedin primar schools %rom September to October ;));, inSu0a !illage "iga Panah subdistrict,Karo district,


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Table 1. Prealence and ariation ofintestinal helminth in !"# subject

$esult


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Intestinal helminth infections Total %

Type of infection:

A. lumbricoides

T. trichiura

Hookworm

Single infection:

A. lumbricoides

T. trichiura

Multiple infection:

A.lumbricoides + T.trichiuraA.lumbricoides + Hookworm

T.trichiura + Hookworm

A.lumbricoides + T.trichiura +

Hookworm

259

289

10

21

51

229

11

8

79.5

88.7

3.1

6.5

15.6

70.2

0.30.3

2.5

Table 1. Prevalence and variation of intestinal helminth in 326Subject


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Characteristic Combination Group Mebendazole

Group

S e x

Boy

Girl

Body weight, kg, mean (SD)

Age, yr, mean (SD)

40

29

27.2 (6.41))

10.6 (1.76)

2 8

3 7

27.8 (6.53

10.5 (1.89)

Table ". Baseline characteristics o%

PM =roup and M =roup


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"he pre!alence o% intestinal helminthiasis inthis stud &as similar to that o% pre!iousstudies. Stud o% 1> elementar schoolstudents in Ja0arta reported thatpre!alences o% A. lumbricoides, ". trichiura,and hoo0&orm &ere /.4, +;, and ;.4,respecti!el

In Malasia, the pre!alence o%A.lumbricoides, ".trichiura, and hoo0&orm&ere ?;.+, +4.(, and ;. respecti!el

%iscussion


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Table !. Mean o% egg reduction rate '@88-%rom the 4st &ee0 until >th &ee0 a%tertreatment

Week PM (%)

N = 69

M (%)

N = 65

P

1st : AL

TT

HW

2nd : AL

TT

3rd : ALTT

4th : AL

TT

98.4

92.6

100

100

97.2

10098

100

97.9

98.3

79.3

100

99.9

94.9

99.998.1

99.9

98.1

>0.05

0.04

>0.05


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9igh pre!alence o% ascariasis andtrichuriasis in this stud probabl due topoor personal hgiene and the condition o%stud location is high in humidit and

agriculture surrounding. In our stud at the end o% stool eamination,

the egg reduction rate '@88- o% Ascarislumbricoides and "richuris trichiura &ere4)) and +(.+ in combination group and++.+ and +.4 in mebenda6ole group.


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egesse used mebenda6ole ; 4)) mg %or 1consecuti!e das and obtained @88 o% ++.and +;.1 %or A. lumbricoides and ". trichiura.Abidin and

8assad used single dose mebenda6ole /)) mgand %ound that the @88 &as ++. and +.(%or A. lumbricoides and ". trichiura,respecti!el.

Abadi used single dose mebenda6ole /)) mgand %ound that @88 &as ++.) and +;. %orA. lumbricoides and ". trichiura.


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Jongsu0suntigul also used single dose mebenda6ole/)) mg and %ound the @88 4)) and +.+ %orA.lumbricoides and ".trichiura.

"here &as signi#cant di7erence in the cure rate

'8- in the (th da o% stool eamination, in &hichcombination &as greater than mebenda6ole group.

But at the end o% the stool eamination, there &asno signi#cant di7erence bet&een the t&o groups.8 o% combination group &ere 4)) and +>.; %orA. lumbricoides and ". trichiura, respecti!el, &hilein mebenda6ole group &ere +?.+ and +;.1 %or A.lumbricoides and ". trichiura, respecti!el.


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Week Combination

group (%)

N = 69

Mebendazol

group (%)

N = 65

P

1st : AL

TT

HW

2nd : AL

TT

3rd : AL

TT4th : AL

TT

92.8

88.4

100

100

91.3

100

92.8100

94.2

76.9

73.8

100

96.9

86.2

96.9

89.296.9

92.3

0.01

0.03

>0.05

Table &. Mean of cure rate (CR) from 1st week until 4th week aftertreatment

AL= Ascaris lumbricoides; TT= Trichuris trichiura; HW=hookworm


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It suggests that combination o% prantelpamoate2mebenda6ole eliminates intestinalhelminth %aster than does single dosemebenda6ol.

Some eperts recommend to use mebenda6olein mass treatment because it is gi!en as a singledose, it has a large spectrum propert, sa%e, andeas to administer &ithout considering bod

&eight.?,( Cn%ortunatel, mebenda6ole is moreepensi!e than other antihelmintics.


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In conclusion, treating intestinal helminthiasis bcombination o% single dose prantel pamoate 4)mg50g bod &eight %ollo&ed b mebenda6ole;4)) mg %or 1 consecuti!e das eliminates

intestinal helminth %aster compared to that bsingle dose /)) mg mebenda6ole onl. 9o&e!erthere is no signi#cant di7erence o% cure rate o%intestinal helminthiasis bet&een bothcombination and single dose mebenda6ole,suggesting that a single dose o% mebenda6ol ispre%erred %or mass treatment o% multiple helminthin%ections.

'onclusion

Treatment of Intestinal Helminthiasis

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