treatment of intestinal helminthiasis
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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
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