Anthelmintic drugs for treating ascariasis

What was the aim of this review?

We aimed to compare the effect of different medications for treating people with Ascaris infection. Albendazole and mebendazole are most commonly used to treat ascariasis. Ivermectin can also be used. We wanted to know if there was anything to choose between these drugs for eradicating the worms and their eggs in stool samples. We included 30 relevant studies.

Key messages

Mebendazole, albendazole, and ivermectin single dose were effective against Ascaris lumbricoides infection, yielding high parasitological cure without any differences detected between them. There were no serious side effects reported.

What was studied in the review?

Ascaris lumbricoides, also known as roundworm, is a soil‐transmitted worm that can infect people. Ascariasis is common worldwide and mainly affects children living in low‐income areas. Interventions against ascariasis include water and sanitation improvement, health education, and medicine treatment for infected individuals. Treatment with medications removes adult worms from the gastrointestinal tract reducing morbidity (illness) and infection transmission. Although many medicines exist to treat people who have worms (anthelmintic drugs), the most effective regimen and the optimal doses are not well known. We assessed studies that compared the use of anthelmintic medications in adults and children, as a single or a combined therapy, and in single or multiple dose regimens.

What were the main results of the review?

We included 30 randomized controlled trials (clinical studies where people are randomly put into one of two or more treatment groups), enrolling 6442 children and adults aged from 28 days to 82 years, with Ascaris infection. Twenty studies were funded or co‐funded by manufacturers (which may introduce bias), while 10 were independent of manufacturer funding.

Parasitological cure is probably six‐fold more frequent in people receiving anthelmintic medicines when compared to people receiving placebo (treatment with no active ingredient) (moderate‐certainty evidence).

No difference in ascariasis cure was found in comparisons between single dose albendazole with single doses of either mebendazole or ivermectin; and no difference was found between single dose albendazole compared with giving multiple doses.

Severe side effects were not reported. The occurrence of other side effects (feeling sick, being sick, diarrhoea, abdominal discomfort, headache, fever) may be uncommon among the compared anthelmintic medicines (moderate‐ to low‐certainty evidence).

How up‐to‐date is this review?

We searched for studies published up to 4 July 2019.

The editorial base of the Cochrane Infectious Diseases Group is funded by UK aid from the UK government for the benefit of low- and middle-income countries (project number 300342-104). The views expressed do not necessarily reflect the UK government’s official policies.