Higher albendazole dose safe, more effective against hookworm

Doubling the recommended dose (400 mg) of albendazole provides greater efficacy against hookworm and is well tolerated in adults, according to the results of a trial.

The trial included 38 preschool-aged children (PSAC), 133 school-aged children (SAC), and 196 adults. Those in the PSAC group were randomized to treatment with 200, 400, or 600 mg of albendazole; patients in other age groups were assigned to groups given the 200-, 400-, 600-, or 800-mg dose or placebo.

There were fewer females in the 200-mg arm in PSAC and higher in the 200-mg arm in SAC and adults. Other baseline characteristics were balanced. Most infections were mild (92–100 percent across treatment arms) in all three age cohorts; only three PSAC, five SAC, and four adults had moderately severe infections, and none had highly severe infections. Coinfection with T. trichiura was detected in one PSAC, six SAC, and two adults, while coinfection with A. lumbricoides was recorded in two PSAC, three SAC, and one adult.

In the adult cohort, cure rates (CRs), assessed 14–21 days after treatment, increased with ascending albendazole doses. The predicted CRs were 16.8 percent, 37.9 percent, 55.6 percent, 67.3 percent, and 74.9 percent in the placebo, 200-, 400-, 600-, and 800-mg arms, respectively. Observed CRs showed a similar pattern, with the highest rate recorded at 94.1 percent in the 800-mg arm.

In the SAC cohort, the predicted dose-response curve increased marginally with CRs, ranging from 64.0 percent in the 200-mg arm to 76.0 percent in the 800-mg arm. Meanwhile, sample size in the PSAC cohort was considered too small to derive meaningful conclusions.

In terms of safety, 10.7 percent and 5.1 percent of participants overall developed any adverse event at 3 hours and 24 hours post-treatment, respectively. Abdominal pain and headache were the most reported AEs.

The findings support use of the currently recommended albendazole doses in the PSAC and SAC cohorts since increasing doses revealed no benefit in these age groups, researchers said. However, in adults, the 800-mg dose demonstrates higher efficacy, and using this dose during mass-drug administration should be explored.