Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
Adv Parasitol. 2019;103:91-115. doi: 10.1016/bs.apar.2018.08.002. Epub 2018 Sep 7.
The soil-transmitted helminths (STHs), Ascaris lumbricoides, hookworm and Trichuris trichiura are common in areas with warm and moist climates with little access to adequate water, sanitation, and hygiene affecting the poorest populations. The current control strategy of the World Health Organization is preventive chemotherapy (PC), i.e., the administration of the two benzimidazoles (albendazole and mebendazole) using single, oral doses to at risk populations without prior diagnosis. The recent success of PC is threatened by anthelmintic drug resistance and the low efficacy of the drugs against hookworm (mebendazole) and T. trichiura (albendazole and mebendazole). Only a handful of alternative drugs with anthelmintic properties are available, however, none of the drugs show high efficacy against all three STHs. The combination of two drugs with different activity profiles presents an attractive alternative, which could prevent the development of drug resistance and increase the efficacy compared to monotherapy. In this review, we summarize the efficacy of current and alternative anthelmintics, coadministrations and triple drug therapies assessed by means of network meta-analysis including only randomized controlled trials. Our results highlight that coadministrations have improved efficacy over monotherapy and the necessity of adapting current STH control strategies for the successful continuation of PC programs.
土壤传播的蠕虫（STHs），如蛔虫、钩虫和鞭虫，在气候温暖潮湿、缺乏充足水、卫生和环境卫生条件的地区很常见，影响最贫困人群。世界卫生组织目前的控制策略是预防性化疗（PC），即对高危人群进行单一、口服剂量的两种苯并咪唑类药物（阿苯达唑和甲苯咪唑）治疗，而无需事先诊断。驱虫药物耐药性和药物对钩虫（甲苯咪唑）和鞭虫（阿苯达唑和甲苯咪唑）的低疗效，威胁着 PC 的近期成功。然而，仅有少数具有驱虫特性的替代药物可用，但是没有一种药物对所有三种 STH 都显示出高疗效。具有不同作用模式的两种药物的联合呈现出一种有吸引力的替代方案，它可以预防耐药性的发展，并与单药治疗相比提高疗效。在这篇综述中，我们通过网络荟萃分析（仅包括随机对照试验）总结了当前和替代驱虫药物、联合用药和三联药物疗法的疗效。我们的结果强调了联合用药比单药治疗具有更高的疗效，并且有必要调整当前的 STH 控制策略，以成功延续 PC 计划。
