背景:土壤传播的蠕虫(STH)感染是儿童发育迟缓的主要原因。为了减轻负担,世界卫生组织(WHO)建议通过在流行地区使用单剂量疗法进行定期驱虫计划.因此,本研究的目的是综合证据,证明在学龄前和学龄儿童中,驱虫药对STH感染的疗效.
方法:本研究遵循系统评价和荟萃分析(PRISMA)标准的首选重新发布项目。相关电子数据库,包括PubMed,Scopus,Embase,DOAJ,科学直接,WHO临床试验.gov图书馆,谷歌学者,和AJOL数据库,搜索相关出版物。随机对照试验(RCTs)和非随机干预研究集中于阿苯达唑和甲苯达唑对儿童STHs的疗效。使用ReviewManager分析数据。使用随机效应模型来获得合并的估计功效。为了评估异质性,采用I2检验和CochraneQ(χ2)。使用Egger检验和漏斗图调查发表偏倚的风险。本审查的方案已在PROSPERO国际前瞻性系统审查登记册(CRD42023401196)上注册。
结果:在选择进行系统评价的69种出版物中,66个完整数据被纳入荟萃分析。单剂量阿苯达唑和甲苯咪唑对蛔虫[95.54%(95%CI:88.75-102.34%)和98.69%(95%CI:97.68-99.65%)显示出令人满意的疗效[减卵率(ERR)],分别。这两种药物对毛虫和钩虫的有效性相对较低(<80%ERR),除了阿苯达唑,对钩虫的ERRs较高[93.44%(95CI:92.39-94.49%)]。阿苯达唑对T.trichiura的治愈率(CR),A.lumbricoides,钩虫占50.8%,91.3%,和78.32%,分别。同样,甲苯咪唑的CRs为48.15%,92.8%,对T.trichiura和49.32%,A.lumbricoides,和钩虫,分别。亚组,如2000年后进行的研究,诊断类型(麦克马斯特),和更长的随访周显着降低了两种药物对毛虫的疗效。而阿苯达唑或甲苯咪唑与其他药物和RCT的组合显示出对毛虫的功效显着提高。每克粪便(EPG)的卵数被确定为对阿苯达唑或甲苯达唑对A.lumbricoides的功效产生负面影响和显着影响的变量之一。
结论:尽管在本综述的不同文章中报道了广泛的ERRs和CR,阿苯达唑和甲苯达唑对STHs的综合估计疗效属于WHO建议中令人满意的类别.有必要进一步评估驱虫药联合作为预防性化疗选择和常规药物疗效测试,以防止耐药性STHs的出现和广泛使用。
BACKGROUND: Soil-transmitted helminthic (STH) infections are the leading cause of stunting among children. To lessen the burden, the World Health Organization (WHO) recommended a periodic deworming program through the use of single-dose therapy in the endemic regions. Therefore, the purpose of this study was to synthesize evidence about the efficacy of anthelminthic drugs against STH infections among preschool and school-age children.
METHODS: The Preferred Reposting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were followed in this study. Relevant electronic databases, including PubMed, Scopus, Embase, DOAJ, Science Direct, the WHO Clinical Trials.gov library, Google Scholar, and AJOL databases, were searched for relevant publications. Randomized controlled trials (RCTs) and non-randomized interventional studies focused on the efficacy of albendazole and mebendazole against STHs in children were included in the study. Review Manager was used to analyze the data. A random effects model was used to obtain the pooled estimated efficacy. To evaluate heterogeneity, the I2 test and Cochrane Q (χ2) were employed. The risk of publication bias was investigated using Egger\'s test and the funnel plot. The protocol of this review was registered at the PROSPERO international prospective register of systematic reviews (CRD42023401196).
RESULTS: Of the 69 publications selected for the systematic review, 66 with complete data were included in the meta-analysis. Single doses of albendazole and mebendazole have shown satisfactory efficacy [egg reduction rate (ERR)] against Ascaris lumbricoides [95.54% (95% CI: 88.75-102.34%) and 98.69% (95% CI: 97.68-99.65%), respectively. The effectiveness of these two drugs against Trichuris trichiura and
hookworms was comparatively low (< 80% ERR), except for albendazole, which showed high ERRs [93.44% (95%CI: 92.39-94.49%)] against
hookworms. The cure rate (CR) of albendazole against T. trichiura, A. lumbricoides, and
hookworms were 50.8%, 91.3%, and 78.32%, respectively. Likewise, mebendazole showed CRs of 48.15%, 92.8%, and 49.32% against T. trichiura, A. lumbricoides, and
hookworms, respectively. Subgroups such as studies conducted after 2000, diagnostic type (McMaster), and longer follow-up weeks significantly reduced the efficacy of the two drugs against T. trichura. While the combination of albendazole or mebendazole with other drugs and RCT showed significantly improved efficacy against T. trichura. The count of eggs per gram of stool (EPG) was identified as one of the variables that negatively and significantly influenced the efficacy of albendazole or mebendazole against A. lumbricoides.
CONCLUSIONS: Despite the wide range of ERRs and CR reported in the different articles included in this review, the pooled estimated efficacy of albendazole and mebendazole against STHs falls in the satisfactory category of WHO recommendations. Further evaluation of the combination of anthelminthic drugs as a preventive chemotherapy option and routine drug efficacy testing are necessary to prevent the emergence and widespread use of drug-resistant STHs.