Article type
Year
Abstract
Background: Strongyloidiasis is a common and globally distributed infection caused by strongyloides stercoralis. This infection is capable of transforming into a serious and sometimes fatal illness in people with comorbilities (malnutrition, immunocompromised, etc). The benzimidazoles and ivermectin are the only two types of drugs available for strongyloidiasis.
Objectives: To evaluate antistrongyloidal drugs for treating strongyloides infection.
Methods: We searched the Cochrane Infectious Diseases Group Specialized Register (July 2010); the Cochrane Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE (1966 to July 2010); EMBASE (1980 to July 2010); LILACS (July 2010). We also searched the metaRegister of Controlled Trials (mRCT) using 'stronglyloid*’ as a search term. Randomized controlled trials of benzimidazoles (including thiabendazole and albendazole) versus ivermectin for treating strongy-loides stercoralis were included.
Results: Ten trials (992 participants) met the inclusion criteria. Seven trials compared benzimidazoles vs Ivermectin, showing an effect in favour of Ivermectin 87% vs 60% (RR 1.40, 95% CI1.11 to 1.78; I2 = 87%, Chi2 p-value=<0.00001. There was no association of failure of therapy with type of benzimidazole. There were several adverse clinical events reported, but no deaths, after administration of benzimidazoles and ivermectin. The most serious adverse event reported in the thiabendazole group was nausea and disorientation. There were more adverse events in the benzimidazole group (overall RR: 1.44, 95% CI 1.23 to 1.70, I2 = 84%, Chi2= 48.98).
Conclusions: Both ivermectin and benzimidazoles are efficacious for treating strongyloidiasis, but ivermectin was superior in terms of efficacy and adverse events. Using ivermectin as a single doses improves adherence. It is not possible to conclude whether ivermectin or benzimidazoles has an effect on morbidity caused by infection. Thiabendazole might be less tolerated than ivermectin or other benzimidazoles based on serious adverse events (disorientation and nausea).
Objectives: To evaluate antistrongyloidal drugs for treating strongyloides infection.
Methods: We searched the Cochrane Infectious Diseases Group Specialized Register (July 2010); the Cochrane Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE (1966 to July 2010); EMBASE (1980 to July 2010); LILACS (July 2010). We also searched the metaRegister of Controlled Trials (mRCT) using 'stronglyloid*’ as a search term. Randomized controlled trials of benzimidazoles (including thiabendazole and albendazole) versus ivermectin for treating strongy-loides stercoralis were included.
Results: Ten trials (992 participants) met the inclusion criteria. Seven trials compared benzimidazoles vs Ivermectin, showing an effect in favour of Ivermectin 87% vs 60% (RR 1.40, 95% CI1.11 to 1.78; I2 = 87%, Chi2 p-value=<0.00001. There was no association of failure of therapy with type of benzimidazole. There were several adverse clinical events reported, but no deaths, after administration of benzimidazoles and ivermectin. The most serious adverse event reported in the thiabendazole group was nausea and disorientation. There were more adverse events in the benzimidazole group (overall RR: 1.44, 95% CI 1.23 to 1.70, I2 = 84%, Chi2= 48.98).
Conclusions: Both ivermectin and benzimidazoles are efficacious for treating strongyloidiasis, but ivermectin was superior in terms of efficacy and adverse events. Using ivermectin as a single doses improves adherence. It is not possible to conclude whether ivermectin or benzimidazoles has an effect on morbidity caused by infection. Thiabendazole might be less tolerated than ivermectin or other benzimidazoles based on serious adverse events (disorientation and nausea).