Paediatrica Indonesiana

VOLUME 53 July ‡ NUMBER 4

Original Article

Mebendazole vs. mebendazole-pyrantel pamoate for

soil-transmitted helminthiasis infection in children
Fereza Amelia, Muhammad Ali, Syahril Pasaribu

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Abstract HOPLQWKLQIHFWLRQVFDXVHGE\VRLOWUDQVPLW
Background6RLOWUDQVPLWWHGKHOPLQWKLDVLV67+LVWKHPRVW
common infection in developing countries. Although it causes
high morbidity, it is still difficult to find the efficacy dose of
antihelmintics for its treatment.
Objective To determine the efficacy of mebendazole and mebenda
]ROHS\UDQWHOSDPRDWHLQWUHDWLQJ67+LQIHFWLRQLQFKLOGUHQ
Methods :HFRQGXFWHGDUDQGRPL]HGRSHQODEHOFRQWUROOHGWULDO
IURP -XO\ WR 6HSWHPEHU  LQ 6HFDQJJDQJ /DQJNDW 'LVWULFW
1RUWK 6XPDWHUD 3URYLQFH ,QGRQHVLD RQ SULPDU\ VFKRRODJHG
FKLOGUHQ%HIRUHWKHLQWHUYHQWLRQGDWDRQDJHVH[QXWULWLRQDO
status, and STH infection status were collected. The children
ZHUHUDQGRPL]HGLQWRWZRJURXSV&KLOGUHQLQJURXS,UHFHLYHGD
VLQJOHGRVHRIPJPHEHQGD]ROHZKLOHWKH\LQJURXS,,UHFHLYHG
DVLQJOHGRVHRIPJRIPHEHQGD]ROHFRPELQHGZLWKPJ
NJ%:RIS\UDQWHOSDPRDWH:HH[DPLQHGVXEMHFWV·VWRROVSHFLPHQV
RQGD\VDQGDIWHUWUHDWPHQWWRGHWHUPLQHFXUHUDWHV
and egg reductions. Statistical analyses were performed by Chi
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YDOXHVRIFRQVLGHUHGWREHVLJQLILFDQW
Results :HIRXQGWKDWWKHFXUHUDWHVZHUHDQG
for Ascaris lumbricoides, Trichuris trichiura, DQGPL[HG (A. lumbricoides
and T. trichiura) infections, respectively, in the mebendazole group.
7KHFXUHUDWHVZHUHDQGIRUA. lumbricoides,
T. trichiura,DQGPL[HG LQIHFWLRQVUHVSHFWLYHO\LQWKHPHEHQGD]ROH
pyrantel pamoate group. Although the cure rate results were not
VLJQLILFDQWO\GLIIHUHQWEHWZHHQWKHWUHDWPHQWJURXSVWKHWRWDOHJJV
per gram (EPG) was significantly lower for both A. lumbricoides and
ted helminths (STH) and schistosomes
are among the most prevalent afflictions
of humans who live in areas of poverty in the
developing world.  $SSUR[LPDWHO\ RQHWKLUG RI
the world’s population is infected with one or more
helminth species which live in the gastrointestinal
tract. Common helminth species are Ascaris
lumbricoides (roundworm), Trichuris trichiura
(whipworm), as well as Ancylostoma duodenale,
and Necator americanus (hookworms).   6RLO
transmitted helminths infections are considered to
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DOWKRXJKQDWLRQDOOHYHOGDWDLVLQFRPSOHWH6XUYH\V
RYHU WKH ² SHULRG LQ 6RXWK(DVW $VLD
UHJLRQUHYHDOHGSUHYDOHQFHVRIPRUHWKDQIRU
Ascaris and Trichuris infections.5 3UHVFKRRODJHG
FKLOGUHQ DFFRXQW IRU ² RI WKH  ELOOLRQ
SHRSOH ZRUOGZLGH ZKR DUH LQIHFWHG ZLWK VRLO
transmitted helminths. 6FKRRODJHG FKLOGUHQ LQ
This study was presented at the Annual Pediatrics Scientifics Meeting,
T. trichiura LQIHFWLRQV3 DQG3 UHVSHFWLYHO\LQWKH
combination therapy group than in the mebendazole alone group.
Conclusion Mebendazole in combination with pyrantel pamoate
has higher efficacy than mebendazole alone in terms of faster egg
reduction rates. However, the cure rates of these two antihelmintics
regimens are similar. [Paediatr Indones. 2013;53:209-13.].
Keywords: mebendazole, pyrantel pamoate, soil
transmitted helminth, children.
,QGRQHVLDQ3HGLDWULFV6RFLHW\3,7,9LQ0HGDQ)HEUXDU\nd²th,

From the Department of Child Health, University of North Sumatera
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Reprint requests to: Fereza Amelia, Department of Child Health,
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Paediatr Indones, Vol. 53, No. 4, July 2013‡209
 Fereza Amelia et al: 0HEHQGD]ROHYVPHEHQGD]ROHS\UDQWHOSDPRDWHIRUVRLOWUDQVPLWWHGKHOPLQWKLDVLVLQIHFWLRQ
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from this condition, as STH infection may manifest
as diarrhea, abdominal pain, poor weight gain,
malnutrition, anemia, and poor intelligence.
Several antihelmintics of various regimens
have been tried in order to eradicate these parasites,
but with varying results. Four antihelmintics are
currently on WHO model list of essential medicines
for the treatment and control of STH, these
are albendazole, mebendazole, levamisole, and
pyrantel pamoate. Mebendazole acts by interfering
with carbohydrate metabolism and inihibitng
polymerization of microtubules. Pyrantel pamoate
has depolarizing effects that causes the dysfunction
of the synaptic transmission in helminth’s body and
neuromuscular blockade development with further
helminth’s muscles paralysis.5
Previous studies state that both drugs have been
IRXQG WR EH HTXDOO\ HIIHFWLYH DJDLQVW HQWHURELDVLV
Pyrantel pamoate is recommended as the drug
of choice in cases of multiple parasitic infections
H[FOXGLQJT. trichiura and S. stercoralis whereas those
with one or both of these in addition to others should
be treated with mebendazole. A systematic review and
PHWDDQDO\VLVUHYHDOVWKDWVLQJOHGRVHRIPHEHQGD]ROH
and pyrantel pamoate pose a high cure rates against
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stool, to look for the egg reduction, and compare it
before and after treatment. This study was approved
by the Ethics Committee of the University of North
Sumatera Medical School.
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ods, the effects of STH infection and antihelmintic
treatment to the subjects and their parents. Before
LQWHUYHQWLRQ GDWD RQ VXEMHFWV· DJHV VH[ QXWULWLRQDO
status, and STH infection status were collected. The
children were divided into two groups by simple ran
domization using a random number table. Children in
JURXS,UHFHLYHGDVLQJOHGRVHRIPJPHEHQGD]ROH
ZKLOHWKH\LQJURXS,,DOVRUHFHLYHGDVLQJOHGRVHRI
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egg reductions and cure rates. Egg reduction was
defined as the decrease in total eggs per gram (EPG)
from the first to the fourth week after treatment. Eggs
per gram is the amount of eggs per slide multiplied by
$FRPSOHWHFXUHZDVGHILQHGDVQRHJJVGHWHFWHG
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after treatment.
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VWDWLVWLFDODQDO\VHVZLWKDVLJQLILFDQFHOHYHORI3
A. lumbricoides.
The aim of this study was to determine the
efficacies of mebendazole alone compared to
mebendazole combined with pyrantel pamoate for
treating STH infection in children.
Methods
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processed with SPSS version 14.0 for Windows.
Results
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not provide stool specimens. We performed stool
:H FRQGXFWHG D UDQGRPL]HG RSHQODEHO FRQWUROOHG
WULDO IURP -XO\ WR 6HSWHPEHU  LQ 6HFDQJJDQJ
Langkat District, North Sumatera Province. Subjects
ZHUHSULPDU\VFKRRODJHGFKLOGUHQLQIHFWHGZLWK67+
who had not received treatment for helminthiasis
for at least one month prior to the study. Children
who refused to take the medication or provide stool
H[DPLQDWLRQV XVLQJ .DWR.DW] WHFKQLTXH RQ 
SULPDU\ VFKRRODJHG FKLOGUHQ DQG IRXQG  ZLWK
STH infections. We enrolled and randomly assigned
them to one of two groups. Figure 1 shows the study
profile.
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specimens, as well as children with diarrhea, cough, or 7KHPHDQVXEMHFWV·DJHVZHUH6'\HDUV
IHYHUZHUHH[FOXGHG,QIRUPHGFRQVHQWZDVREWDLQHG LQWKHPHEHQGD]ROHJURXSDQG6'\HDUVLQ
from parents or guardians. Sample size was calculated FRPELQDWLRQJURXS)LIW\VL[FKLOGUHQZHUH
DQG  FKLOGUHQ LQ HDFK JURXS ZHUH UHTXLUHG found with A. lumbricoides LQIHFWLRQ  FKLOGUHQ
Helminthiasis diagnosed based on any of helminth ZLWKT. Trichiura, DQGFKLOGUHQ
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210‡Paediatr Indones, Vol. 53, No. 4, July 2013

 Fereza Amelia et al: 0HEHQGD]ROHYVPHEHQGD]ROHS\UDQWHOSDPRDWHIRUVRLOWUDQVPLWWHGKHOPLQWKLDVLVLQIHFWLRQ

of subjects were similar between the two groups

Table 1. Baseline characteristics of subjects
(Table 1).
Group I Group II
Characteristics
OGDGPFC\QNG (combination)
We found no significant difference in cure
(n=65) (n=65) UDWHV EHWZHHQ JURXSV ,Q WKH PHEHQGD]ROH DORQH
Gender, n (%) JURXSWKHFXUHUDWHVZHUHDQGIRUA.
Females 33 (50.7) 36 (55.3) lumbricoides and T. trichiura infections, respectively.
Males 32 (49.3) 29 (44.7)
,Q WKH PHEHQGD]ROHS\UDQWHO SDPRDWH JURXS WKH
Mean age (SD), years 9.6 (1.99) 9.0 (2.83)
Mean weight (SD), kg 22.7 (6.78) 20.5 (3.54) FXUHUDWHVZHUHDQGIRUA. lumbricoides
Mean height (SD), cm 131 (9.72) 113 (14.80) and T. trichiura infections, respectively. Similarly, in
Nutritional status, n (%) WKH PL[HG LQIHFWLRQ SDWLHQWV FXUH UDWHV ZHUH QRW
Severely malnourished 2 (3) 5 (7.7) significantly different between the mebendazole alone
Moderately malnourished 18 (27.6) 4 (6.1)
Mildly malnourished 31 (47.6) 24 (37) DQG WKH FRPELQDWLRQ WKHUDS\ JURXSV  DQG
Well-nourished 14 (21.8) 30 (46.2) UHVSHFWLYHO\(Table 2).
Overweight 0 1 (1.5) Table 3 shows the egg reduction rate for the two
Obese 0 1 (1.5)
JURXSV7KHUHZHUHVLJQLILFDQWGLIIHUHQFHVRQWKHth
Mean total eggs per gram (SD)
Ascaris lumbricoides 1,160.4 (59.8) 1,011.9 (58.6) day after treatment for both groups, the total EPG
Trichuris trichiura 131.9 (12.7) 118.1 (10.6) UHGXFHG IDVWHU RQ PHEHQGD]ROHS\UDQWHO SDPRDWH
combination group.

Table 2. Cure rates by group for two STH species

Parasites Antihelmintics regimens Cure rate, % P value
A. lumbricoides OGDGPFC\QNG 95.4 0.081
OGDGPFC\QNG R[TCPVGNRCOQCVG 98.5
T. trichiura OGDGPFC\QNG 78.5 0.067
OGDGPFC\QNG R[TCPVGNRCOQCVG 89.2
Mixed A. lumbricoides OGDGPFC\QNG 89.3 0.063
T. trichiura OGDGPFC\QNG R[TCPVGNRCOQCVG 90.2

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specimens

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67+LQIHFWLRQQ 

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Figure 1.5VWF[RTQſNG

Paediatr Indones, Vol. 53, No. 4, July 2013‡211

 Fereza Amelia et al: 0HEHQGD]ROHYVPHEHQGD]ROHS\UDQWHOSDPRDWHIRUVRLOWUDQVPLWWHGKHOPLQWKLDVLVLQIHFWLRQ

Table 3. Egg reduction rate at the 1st week and 4th week
Parasites Antihelmintics regimen Total eggs per gram
Mean (SD) Mean (SD) 95% CI P value
7th day 28th day reduction
A. lumbricoides OGDGPFC\QNG 871.4 (52.2) 30.2 (5.8) 0.36-2.58 0.001
OGDGPFC\QNG 92.4 (7.3) 9.1 (0.8) 0.46-1.59
R[TCPVGNRCOQCVG
T. trichiura OGDGPFC\QNG 472.3 (50.4) 10.8 (1.9) 0.35-2.57 0.002
OGDGPFC\QNG 93.1 (9.3) 3.6 (1.2) 0.46-1.50
R[TCPVGNRCOQCVG

Discussion
Factors influencing the STH prevalence rate are
hygiene, sanitation, socioeconomic level, knowledge,
HGXFDWLRQDOOHYHODQGHQYLURQPHQWDOGLIIHUHQFHV,Q
1RUWK6XPDWHUDLQWKHSUHYDOHQFHRI67+ZDV
DERXW²,QYLOODJHVHYHQWKRXJKWKHSDWWHUQ
of STH transmission is generally similar, different
lifestyles may affect helminthiasis transmission, as
shown by differing prevalences between areas.
We found that the prevalence of STH infection
in Secanggang, Kabupaten Langkat, North Sumatera
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VWXG\LQLQ6XND9LOODJH7LJD3DQDK6XEGLVWULFW
.DEXSDWHQ.DUR1RUWK6XPDWHUD3URYLQFH,QWKLV
FOLQLFDOWULDODFRPELQDWLRQRIDVLQJOHGRVHRIPJ
NJERG\ZHLJKWS\UDQWHOSDPRDWHIROORZHGE\PJ
mebendazole twice a day for three consecutive days
eliminated intestinal helminths faster than a single
GRVH RI  PJ PHEHQGD]ROH DORQH EXW WKHUH ZDV
no significant difference in cure rate from intestinal
helminthiasis between the combination and single
dose mebendazole groups.
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Pancur Batu Subdistrict, Kabupaten Deli Serdang,
1RUWK6XPDWHUD3URYLQFHVKRZHGWKDWPJVLQJOH
subjects with A. lumbricoides LQIHFWLRQ  T. GRVHDOEHQGD]ROHRUDOO\KDGKLJKHUHIILFDF\WKDQ
trichiuraLQIHFWLRQDQGPL[HGLQIHFWLRQA. PJNJERG\ZHLJKWS\UDQWHOSDPRDWHDVDVLQJOHRUDO
lumbricoides and T. trichiuraEXWQRVXEMHFWV
had hookworm infection.
Several antihelmintics in varying regimens
have been tried to eradicate those parasites with
various results.  Medications recommended by
WHO for reducing morbidity due to STH include
albendazole, levamisole, mebendazole, and pyrantel
pamoate. World Health Organization mebendazole
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hookworm infections. WHO also recommended
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weight for pyrantel.
We found that mebendazole combined with
pyrantel pamoate had better efficacy in treating STH
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group than in the mebendazole group, but there was
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day after treatment.
Our findings were in agreement with a previous
212‡Paediatr Indones, Vol. 53, No. 4, July 2013
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orally for three consecutive days.
Adverse effects from mebendazole therapy that
were occasionally reported were transient gastrointes
tinal discomfort and headaches. Mild gastrointestinal
disturbance, headaches, dizziness, drowsiness, insom
nia, and rash have been occasionally reported during
pyrantel pamoate treatment.Vomiting was found
in five children in the combination group, and in two
children in the mebendazole group in our study. No
other adverse effects were noted.
,QFRQFOXVLRQ mebendazole in combination with
pyrantel pamoate has higher efficacy than mebenda
zole alone in terms of faster egg reduction rates,
however, the cure rates of these two antihelmintics
regimens are similar.
References
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Silva N, et al+HOPLQWKLQIHFWLRQV6RLOWUDQVPLWWHGKHOPLQWK
LQIHFWLRQV DQG VFKLVWRVRPLDVLV ,Q +RWH] 3- %XQG\ '$3
 Fereza Amelia et al: 0HEHQGD]ROHYVPHEHQGD]ROHS\UDQWHOSDPRDWHIRUVRLOWUDQVPLWWHGKHOPLQWKLDVLVLQIHFWLRQ

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FRXQWULHVQGHG:DVKLQJWRQ'&World BankS

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).8,S
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1HJO7URS'LVH
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Katz SL, editors. Krugman’s infectious disease in children.
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,PPXQRO
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,QGRQHV
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of schistosomiasis and soil transmitted helminthiasis. Geneva,
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Treatment of intestinal helminthiasis: mebendazole only
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information: drugs used in parasitic disease. Geneva,
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Paediatr Indones, Vol. 53, No. 4, July 2013‡213