Short Communication - Albendazole in the Treatment of Ancylostomiasis, Ascariasis, Taeniasis and Amoebiasis in School Children.
Keywords: Albendazole, School children, Intestinal parasitic infection, Egg per gram, Drugs administration.
Intestinal parasitic infections (IPIs) are one of the major health problems in the world. It is estimated that over two billion people are infected with intestinal pathogenic parasites and five billion live in areas where intestinal parasites are endemic (Hotez et al., 2003). Mass treatment of IPIs in developing countries, is highly endemic and has been reported to be highly effective (WHO, 1981). Chemotherapeutic practices are usually effective where other involvements, e.g. health education, the improvement of environmental sanitation, the provision of clean water supply and nutritional supplements, are not available (Hayashi, 1981).
Mebendazole, albendazole and triclabendazole have a wide range of effectiveness against helminth infections. These drugs have been licensed in different parts of the globe for human use (Horton, 2000). Albendazole, mebendazole, as well as pyrantel pamoate and levamisole are recommended drugs against infection with soil transmitted helminths (Albonico et al., 1999; WHO, 2010). Albendazole and mebendazole is known to be effective for the treatment of Ascaris lumbricoides (Adugna et al., 2007) in human from Africa and southern America (Diawara et al., 2009; Cezar et al., 2010). Albendazole has been administered in animal models as well as in human beings for the treatment of helminth parasitic diseases. Albendazole is effective remedy against the helminths parasitic diseases caused by eggs and larvae of various helminth parasites (Cline et al., 1984).
Diseases caused by tapeworms remain a public health problem in low and middle-income countries including Pakistan (Khan et al., 2018). Amoebiasis results in considerable gastrointestinal morbidity, malnutrition and mortality, particularly among children in developing countries (Feng and Xiao, 2011). A number of drugs are used to treat intestinal protozoa infections. Most commonly used are nitroimidazole including metronidazole, tinidazole, ornidazole and secnidazole (Escobedo et al., 2009). Nitazoxanide and albendazole are the alternative effective agents (Ortiz et al., 2001; Yereli et al., 2004). Metronidazole is low in toxicity and is effective against both extra-intestinal and colonic infections (Robert and Janovy, 2008). It is the drug commonly used and recommended in the treatment of amoebiasis (Barwari, 2006). IPIs are usually treated with different drugs, therefore a continued follow up is needed.
To the best of our knowledge no work has been published on the treatment of intestinal parasitic infection through synthetic drugs in Pakistan. This study is aimed to determine the efficacies of two brands of albendazole on the treatment of ancylostomiasis, ascariasis, taeniasis and amoebiasis in children of school at University of Malakand, Pakistan.
Materials and methods
All the infected school children (6-15 year of age) from Public School, University of Malakand, KPK, Pakistan were included in this study. These children had no history of prior use of antihelminthic drugs. All the children were instructed to maintain the clinical supervision throughout the period of the experiment. This study is approved from Ethical Review Committee, University of Malakand in collaboration with District Headquarter Hospital Timergara, Dir Lower, Pakistan.
All the school children, infected with intestinal parasites, selected on the basis of microscopic detection of egg per gram (EPG) of faeces. All the children were randomly divided into 2 groups - A and B. The students in Group A were treated with albendazole (bendazol) systematic (International Union of Pure and Applied Chemistry) (GlaxoSmithKline, Pakistan), 400 mg and students in group B were treated with albendazole (zentel) 200mg (Reg. No. Q/12/75, Gloxosmithkline South Africa (Pvt.) Ltd.) orally as a single dose/kg once a time. EPG were calculated by the McMaster techniques given by (Jarvie et al., 2005) prior and after the treatment. The% efficacies at 95% C.I. of the drugs were measured by the formula given by Thrusfield (2005) as:
Efficacy of drug tr. (%) = Mean pre-tr. EPG -
Mean post-tr. EPG x 100 / Mean pre-tr. EPG
Where, tr. is treatment.
The data was analyzed by Graph Pad version-5. P value < 0.05 was considered significant statistically.
Results and discussion
Efficacy of the drugs prescribed was noted via the counting of eggs in per gram of the stool before and after treatment (Table I). Percent high egg negative rate (ENR) was noted for albendazole (bendazol) against ancylostomiasis and amoebiasis and albendazole (zentel) against ascariasis and taeniasis. Using the per-protocol analysis, albendazole (bendazol) attained 92, 83, 74 and 84% ENR, although single doses of albendazole (zentel) resulted 83, 96, 81 and 74% of ENR (Table II). Comparing the treatment outcomes using the chi square test revealed that albendazole (bendazol) was more effective on infections with ancylostomiasis and amoebiais than albendazole (zentel) and albendazole (zentel) was found more effective for ascariais and taeniais than albendazole (bendazol). No adverse effect was observed except for albendazole (bendazol) a case resulted gastrointestinal trouble, vomiting and diarrhea, cured with analgesic prescription by the physician.
Number of eggs before treatment was 16000 and after treatment was counted as 1856 for A. duodenale (Table II). Findings of the present study agreed with the study conducted by Khan et al. (2018) who reported 83% and 75% efficacies, respectively after administration of albendazole (bendazol) 400mg/kg and albendazole (zentel) 200mg/kg against hymenolepiasis. Findings of present study were also comparable to that of Steinmann et al. (2011) showing 92-95% efficacy against Ancylostoma duodenale infestation. Studies conducted in Brazil, Cambodia, Cameroon, Ethiopia, India, Tanzania and Vietnam claimed 88.5%, 87.4%, 87.1%, 98.9%, 74.7%, 86.8% and 100% efficacy of albendazole, respectively (Vercruysse et al., 2011).
Present study reveals 83% and 96% efficacy of Albendazole (400mg/kg) and albendazole (200mg/kg) against ascariasis. Findings of the present study do not agreed with the study conducted by Khan et al. (2018), who reported high efficacy of zentel against ascariasis than bendazol. In a study conducted by Speich et al. (2012), oral administration of albendazole showed 100% cure against A. lumbricoides infection, while in present trial this rate was 83% against ascariasis. Regarding ENR the results of the current trial agree with those reported by Rahman (1996) who showed above 90% in relation to mebendazole and albendazole for A. lumbricoides.
Table I.- Number of eggs counted per gram (NEPG) before and after treatment for intestinal parasites in school children, University of Malakand, Lower Dir, Pakistan.
Parasite###Albendazole(400mg/kg)###% efficacy###Albendazole(200mg/kg)###% efficacy
###NEPG before###NEPG after###NEPG before###NEPG after
Table II.- Total number of eggs in present in both groups before and after treatment among subjects positive for intestinal parasites in school children, University of Malakand, Lower Dir, Pakistan.
Parasite###No. of eggs of both groups###No. of eggs becoming###Egg remaining###P-value
Present study demonstrated that 5750 eggs before treatment were reduced to 1320 eggs after treatment were noted for T. saginata, respectively (Table II). Findings of the present study were different from that of Khan et al. (2018), who reported that the administration of albendazole (400mg/kg) and albendazole (200mg/kg) against hymenolepiasis revealed 83% and 75% efficacies, respectively. Hamid et al. (2005) reported that the administration of 10-20mg of Parazequental show 90% efficacy against the beef tapeworm. In a study conducted by Ahmed et al. (1986) albendazole showed 100% efficacy against taeniasis. In other research (Misra et al., 1984) show 57-70% efficacy of albendazole against taeniasis. The albendazole was 100% effective in taeniasis in children when administered for 3 consecutive days (Ahmed et al., 1986).
The study conducted by Misra et al. (1984) showed that a single dose of albendazole (400mg) was effective 57% to 70% against taeniasis while the same dose for 3 consecutive days increased the success rate to 100%. Similarly, single dose (10-20mg) of parazequentel revealed 90% efficacy against the beef tapeworm infection (Hamid et al., 2005).
Present study showed reduction of E. histolytica eggs from 1800 to 361 (Table II) after treatment with albendazole (bendazol) (400mg/kg) and albendazole (zentel) (200mg/kg) which show 84 and 74% efficacy against amoebiasis. These results are in agreement with that of Khan et al. (2018), who reported 83% and 75% efficacies, respectively after administration of albendazole (400mg/kg) and albendazole (200mg/kg) against Hymenolepiasis. Metronidazole is the drug of choice for treatment of invasive amoebiasis. Iodoquinol, paromomycin, and diloxanide furoate are the current recommended drugs for the treatment of noninvasive amoebiasis. Iodoquinol is given orally three times a day for 20 days. Nausea, vomiting, diarrhea, and abdominal pain are the associated side effects. Paromomycin is given orally three times a day for 7 days.
Diloxanide furoate is given three times a day for 10 days. Side effects include gastrointestinal symptoms, such as nausea, vomiting, and flatulence (Li and Stanly, 1996; Huges and Petri, 2000).
Albendazole (bendazol) appear to be well-tolerated and effective drug in the treatment of ancylostomiasis and amoebiasis while Albendazole (zentel) represents more effectiveness against ascariasis and taeniasis in school children.
This research is facilitated under the research project (SRGP #21-61) granted by higher education commission, Islamabad, Pakistan.
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|Author:||Khan, Wali; Iqbal, Mudassar; Khan, Israr|
|Publication:||Pakistan Journal of Zoology|
|Date:||Aug 31, 2019|
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