Efficacy of Repeated-Dose Albendazole/ Mebendazole Regimens for Soil-Transmitted Helminth Infections in Paediatric Population: A Systematic Review and Meta-Analysis
- 1Government Medical College Badaun
Abstract
BackgroundThe primary approach to controlling soil-transmitted helminths (STH) is preventive chemotherapy using single-dose benzimidazoles. However, single-dose regimens frequently result in suboptimal clearance against species like Trichuris trichiura and hookworm. This systematic review and meta-analysis evaluated the comparative efficacy of repeated-dose versus standard single-dose albendazole or mebendazole regimens in paediatric populations.
MethodsRegistered prospectively on PROSPERO (CRD420261491616), a comprehensive search of PubMed, Embase, Cochrane Library, and Google Scholar was conducted from database inception up to September 1, 2026, restricted to English-language publications. The search identified clinical trials comparing repeated-dose against single-dose albendazole or mebendazole in paediatric STH infections. Primary outcomes were cure rate (CR) and egg reduction rate (ERR). Random-effects models synthesized pooled odds ratios (OR) and mean differences (MD). Risk of bias was assessed using the Cochrane RoB 2 tool.
ResultsFive randomized clinical trials (N = 1,718 participants) met the inclusion criteria. Overall, repeated dosing demonstrated significant superiority in cure rate (pooled OR = 4.47, 95% CI: 1.58-12.67; I{superscript 2} = 92%) and egg reduction rate (pooled MD = 0.17, 95% CI: 0.01-0.32; I{superscript 2} = 87%).
DiscussionRepeated-dose benzimidazole regimens offer superior overall therapeutic efficacy compared to standard single-dose administration in children. However, this therapeutic advantage is drug-specific: multi-dose albendazole consistently enhances parasite clearance across trial settings, whereas multi-dose mebendazole exhibits variable performance and lacks conclusive superiority over single dosing.
ConclusionTransitioning to targeted, multi-dose albendazole protocols--rather than mebendazole--may serve as an effective public health intervention to eliminate residual parasite reservoirs in high-transmission endemic regions.
Author summaryWhile current WHO guidelines recommend single-dose preventive chemotherapy for soil-transmitted helminths, standard regimens often fail to achieve optimal clearance for Trichuris trichiura and hookworms. Our meta-analysis of randomized clinical trials (N = 1,718 children) demonstrates that repeated-dose regimens significantly improve cure rates (pooled OR = 4.47; post-sensitivity OR = 2.60) and egg reduction rates (pooled MD = 0.17; post-sensitivity MD = 0.08), driven specifically by albendazole (cure rate OR = 3.10, I-squared = 7%; egg reduction rate pooled MD = 0.07, 95% CI: 0.03-0.11, I-squared = 0%, Z = 3.29, P = 0.001) rather than mebendazole. This work provides key empirical evidence that shifting public health policy from single-dose mass drug administration to targeted, multi-dose albendazole in high-transmission hotspots can effectively eliminate persistent parasite reservoirs and prevent therapeutic failure.
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BibTeX
@misc{singh2026efficacy,
title = {{Efficacy of Repeated-Dose Albendazole/ Mebendazole Regimens for Soil-Transmitted Helminth Infections in Paediatric Population: A Systematic Review and Meta-Analysis}},
author = {N. Singh and P. Sahu and V. Singh and P. P. Bharti and A. M. Siddiqui and A. Kumar},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.09.26365109},
url = {https://www.medrxiv.org/content/10.64898/2026.10.09.26365109v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Efficacy of Repeated-Dose Albendazole/ Mebendazole Regimens for Soil-Transmitted Helminth Infections in Paediatric Population: A Systematic Review and Meta-Analysis
AU - N. Singh
AU - P. Sahu
AU - V. Singh
AU - P. P. Bharti
AU - A. M. Siddiqui
AU - A. Kumar
PY - 2026
DA - 2026/10/09
PB - medRxiv
DO - 10.64898/2026.10.09.26365109
UR - https://www.medrxiv.org/content/10.64898/2026.10.09.26365109v1
AB - BackgroundThe primary approach to controlling soil-transmitted helminths (STH) is preventive chemotherapy using single-dose benzimidazoles. However, single-dose regimens frequently result in suboptimal clearance against species like Trichuris trichiura and hookworm. This systematic review and meta-analysis evaluated the comparative efficacy of repeated-dose versus standard single-dose albendazole or mebendazole regimens in paediatric populations. MethodsRegistered prospectively on PROSPERO (CRD420261491616), a comprehensive search of PubMed, Embase, Cochrane Library, and Google Scholar was conducted from database inception up to September 1, 2026, restricted to English-language publications. The search identified clinical trials comparing repeated-dose against single-dose albendazole or mebendazole in paediatric STH infections. Primary outcomes were cure rate (CR) and egg reduction rate (ERR). Random-effects models synthesized pooled odds ratios (OR) and mean differences (MD). Risk of bias was assessed using the Cochrane RoB 2 tool. ResultsFive randomized clinical trials (N = 1,718 participants) met the inclusion criteria. Overall, repeated dosing demonstrated significant superiority in cure rate (pooled OR = 4.47, 95% CI: 1.58-12.67; I{superscript 2} = 92%) and egg reduction rate (pooled MD = 0.17, 95% CI: 0.01-0.32; I{superscript 2} = 87%). DiscussionRepeated-dose benzimidazole regimens offer superior overall therapeutic efficacy compared to standard single-dose administration in children. However, this therapeutic advantage is drug-specific: multi-dose albendazole consistently enhances parasite clearance across trial settings, whereas multi-dose mebendazole exhibits variable performance and lacks conclusive superiority over single dosing. ConclusionTransitioning to targeted, multi-dose albendazole protocols--rather than mebendazole--may serve as an effective public health intervention to eliminate residual parasite reservoirs in high-transmission endemic regions. Author summaryWhile current WHO guidelines recommend single-dose preventive chemotherapy for soil-transmitted helminths, standard regimens often fail to achieve optimal clearance for Trichuris trichiura and hookworms. Our meta-analysis of randomized clinical trials (N = 1,718 children) demonstrates that repeated-dose regimens significantly improve cure rates (pooled OR = 4.47; post-sensitivity OR = 2.60) and egg reduction rates (pooled MD = 0.17; post-sensitivity MD = 0.08), driven specifically by albendazole (cure rate OR = 3.10, I-squared = 7%; egg reduction rate pooled MD = 0.07, 95% CI: 0.03-0.11, I-squared = 0%, Z = 3.29, P = 0.001) rather than mebendazole. This work provides key empirical evidence that shifting public health policy from single-dose mass drug administration to targeted, multi-dose albendazole in high-transmission hotspots can effectively eliminate persistent parasite reservoirs and prevent therapeutic failure.
ER -