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Randomised trial of albendazole and pyrantel in symptomless trichuriasis in children
J E Forrester1, J C Bailar, S A Esrey
1Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
Insights
Symptomless Trichuris trichiura infection hinders child growth. Anthelmintic drugs like albendazole and pyrantel may also impact growth, warranting further investigation into potential toxic effects.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Trichuris trichiura (whipworm) infections are common globally.
- Symptomless infections may impact child development.
- The effect of anthelmintic treatment regimens on growth requires clarification.
Purpose of the Study:
- To determine if asymptomatic Trichuris trichiura infection is linked to impaired child growth.
- To evaluate the impact of different anthelmintic drug dosages on children's growth.
Main Methods:
- A community-based trial involving 622 Mexican children.
- Random allocation to three treatment groups: high-dose albendazole (3 days), standard-dose albendazole (1 dose), or pyrantel (1 dose).
- Growth monitoring over 12 months with intention-to-treat analysis.
Main Results:
- High-dose albendazole showed a significant increase in arm circumference in children with heavy infections compared to pyrantel.
- In children with low-level infections, high-dose albendazole was associated with less favorable changes in weight, arm circumference, and triceps skinfold thickness compared to pyrantel.
- 18% of children were lost to follow-up across all groups.
Conclusions:
- Asymptomatic trichuriasis negatively affects child growth.
- Albendazole and pyrantel treatments may influence growth independently of their antiparasitic effects.
- Potential toxic effects of high-dose albendazole necessitate further research.
Background:
We aimed to find out whether symptomless infection with Trichuris trichiura is associated with impairment of growth and to assess the effect of a multiple-doses regimen of anthelmintic drugs on the growth of children.
Methods:
In a community based trial, 622 Mexican children were randomly allocated one of three treatment regimens: 3 days of albendazole 400 mg daily (high efficacy); one dose of albendazole 400 mg (moderate efficacy); one dose of pyrantel (pyrantel embonate) 11 mg/kg (low efficacy). Growth was monitored for 12 months. Analyses were by intention to treat.
Findings:
113 (18%) children were lost to follow-up--34 from the pyrantel group, 45 from the albendazole 400 mg group, and 34 from the albendazole 1200 mg group. Among the 127 children with heavy pretreatment infections, albendazole 1200 mg was better than pyrantel in terms of an increase in arm circumference (mean 0.26 cm, p=0.044). Among the 381 children with low pretreatment levels of infection, changes in weight (mean difference between groups -0.33 kg, p=0.036), arm circumference (-0.18 cm, p=0.0095), and thickness of triceps skinfold (-0.41 mm, p=0.0031) were less in children on albendazole 1200 mg than in those on pyrantel.
Interpretation:
Symptomless trichuriasis impairs growth and albendazole or pyrantel may affect growth, independently of a therapeutic action on parasites. Possible toxic effects of high-dose albendazole require further investigation.