PubMed · 9533454
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P Venkatesan. 1998. Albendazole.. https://doi.org/10.1093/jac%2F41.2.145
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BACKGROUND: Currently, more than 600,000 immigrants enter the United States each year from countries where intestinal parasites are endemic. At entry persons with parasitic infections may be asymptomatic, and stool examinations are not a sensitive method of screening for parasitosis. Albendazole is a new, broad-spectrum antiparasitic drug, which was approved recently by the Food and Drug Administration. International trials have shown albendazole to be safe and effective in eradicating many parasites. In the United States there is now disagreement about whether to screen all immigrants for parasites, treat all immigrants presumptively, or do nothing unless they have symptoms. METHODS: We compared the costs and benefits of no preventive intervention (watchful waiting) with those of universal screening or presumptive treatment with 400 mg of albendazole per day for five days. Those at risk were defined as immigrants to the United States from Asia, the Middle East, sub-Saharan Africa, Eastern Europe, and Latin America and the Caribbean. Cost effectiveness was expressed both in terms of the cost of treatment per disability-adjusted life-year (DALY) averted (one DALY is defined as the loss of one year of healthy life to disease) and in terms of the cost per hospitalization averted. RESULTS: As compared with watchful waiting, presumptive treatment of all immigrants at risk for parasitosis would avert at least 870 DALYs, prevent at least 33 deaths and 374 hospitalizations, and save at least $4.2 million per year. As compared with watchful waiting, screening would cost $159,236 per DALY averted. CONCLUSIONS: Presumptive administration of albendazole to all immigrants at risk for parasitosis would save lives and money. Universal screening, with treatment of persons with positive stool examinations, would save lives but is less cost effective than presumptive treatment.
Alveolar echinococcosis (A. E.), caused by Echinococcus multilocularis, behaves biologically like a malignant tumour of the liver which is best treated by radical surgery. However, radical surgery can be performed only in about 20-30% of A. E. cases. The efficacy of chemotherapy with benzimidazole derivatives for inoperable cases is debated. The results of a prospective Swiss chemotherapy trial, which started in 1976, are reviewed. In the last 20 years a total of 110 patients has been included in our protocol and 74 of these patients had inoperable or palliatively operated A. E. (average observation time 12.8 years). The efficacy of long-term chemotherapy was documented by increase of 10-year survival compared to historical (untreated) A. E. cases (80 vs 6%) and by reduction or stabilisation of the liver lesions in 83% of cases during long-term chemotherapy. Several relevant problems remain to be clarified, e.g. optimal duration of chemotherapy, the controversy as to whether chemotherapy is parasitostatic or parasitocidal, the establishment of reliable routine methods for short-term assessment of therapeutic efficacy, and comparative studies between mebendazole and albendazole. Furthermore, additional studies are necessary in collaboration with basic science, for example on the impact of the increasing fox population, with invasion of large agglomerations, on infection risk in the Swiss population, and the importance of individual immune competence for susceptibility or resistance to A. E.
The benzimidazole derivatives, albendazole and fenbendazole were evaluated for their effectiveness in the treatment and prevention of histomonosis (blackhead) in turkeys. Histomonosis was produced in 5 week-old birds by placing them on broiler breeder litter known to be contaminated with Heterakis gallinae ova and the protozoan Histomonas meleagridis. In the first trial, at the onset of confirmed clinical disease, birds were treated orally with metronidazole, a compound known to be effective against Histomonas. Those receiving metronidazole had significantly greater mean body weight gains during the treatment period and the 2 weeks following treatment than untreated controls. Treated birds also had significantly lower caecal and liver lesion scores. These findings served to validate the method of disease reproduction and establish its suitability for testing the benzimidazoles. Similar trials were conducted to determine the therapeutic value of albendazole at 100.0 mg/kg of body weight and fenbendazole at 10.0 mg/kg body weight, administered orally twice a day for 5 consecutive days. Under these conditions, both drugs were found to be ineffective as treatments. A final trial was conducted to assess the prophylactic value of albendazole and fenbendazole administration. At the time of placement on contaminated litter, birds were medicated as previously described with the exception that treatment was continued for 14 consecutive days, the approximate incubation period for histomonosis. The trial was terminated on the 16th day. In the case of both albendazole and fenbendazole, treatment was associated with a significant increase in mean body weight gain and lower caecal and liver lesion scores. It is believed that the observed prophylactic effect may be attributed to the destruction of the transport vector e.g., Heterakis larvae, or to direct killing of the flagellated form of Histomonas which is normally found in the caecal lumen and is considered to be more sensitive to chemotherapeutic agents than the amoeboid form found in tissues.