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Assessing the efficacy of albendazole against hookworm in Vietnam using quantitative PCR and sodium nitrate flotation

Preventive chemotherapy (PC), consisting of the regular distribution of anthelmintics to populations or groups of populations at risk, is the primary tool used to control soil-transmitted helminth (STH) infections. This strategy, whilst cost-effective, raises the concern of potential emergence of dr...

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Autores principales: Dyer, Clare E. F., Clarke, Naomi E., Nguyen, Dinh Ng, Herath, H. M. P. Dilrukshi, Hii, Sze Fui, Pickford, Russell, Traub, Rebecca J., Vaz Nery, Susana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9668116/
https://www.ncbi.nlm.nih.gov/pubmed/36315591
http://dx.doi.org/10.1371/journal.pntd.0010767
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author Dyer, Clare E. F.
Clarke, Naomi E.
Nguyen, Dinh Ng
Herath, H. M. P. Dilrukshi
Hii, Sze Fui
Pickford, Russell
Traub, Rebecca J.
Vaz Nery, Susana
author_facet Dyer, Clare E. F.
Clarke, Naomi E.
Nguyen, Dinh Ng
Herath, H. M. P. Dilrukshi
Hii, Sze Fui
Pickford, Russell
Traub, Rebecca J.
Vaz Nery, Susana
author_sort Dyer, Clare E. F.
collection PubMed
description Preventive chemotherapy (PC), consisting of the regular distribution of anthelmintics to populations or groups of populations at risk, is the primary tool used to control soil-transmitted helminth (STH) infections. This strategy, whilst cost-effective, raises the concern of potential emergence of drug resistance. The efficacy of anthelmintics against STH infections is measured using cure rate (CR) and egg reduction rate (ERR), using microscopy-based techniques such as the Kato-Katz thick smear. However, Kato-Katz has low sensitivity, especially for low-intensity infections, and requires fresh samples that need to be processed quickly. Realtime quantitative PCR (qPCR), which is more sensitive, is emerging as a “gold standard” for STH diagnostics given its higher sensitivity (important in low prevalence settings) and ability to differentiate hookworm species, while sodium nitrate flotation (SNF) may provide a low-cost more sensitive and practical alternative to Kato-Katz in the field. In this study, we examined the efficacy of a locally manufactured brand of albendazole 400 mg (“Alzental”) against hookworm in Đắk Lắk province, Vietnam, using both qPCR and SNF. For qPCR, formulae to convert qPCR cycle threshold (Ct) values into eggs per gram of faeces (EPG) were utilised to determine efficacy calculations, and these values directly compared with efficacy values generated using SNF. Factors associated with CR and ERR were examined, and Alzental tablet quality was assessed by comparing with an Australian TGA-approved equivalent “Eskazole” tablet. We observed a CR and ERR of 64.9% and 87.5% respectively using qPCR, and 68.4% and 67.6% respectively using SNF. The tablet composition of Alzental was comparable to Eskazole in terms of active albendazole drug concentration with no evidence of impurities. This study demonstrates that the efficacy of Alzental against hookworm is within the range of previously reported studies for albendazole 400 mg. The study also demonstrates the value of qPCR and SNF as alternatives to standard Kato-Katz methodology for assessment of anthelmintic efficacy.
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spelling pubmed-96681162022-11-17 Assessing the efficacy of albendazole against hookworm in Vietnam using quantitative PCR and sodium nitrate flotation Dyer, Clare E. F. Clarke, Naomi E. Nguyen, Dinh Ng Herath, H. M. P. Dilrukshi Hii, Sze Fui Pickford, Russell Traub, Rebecca J. Vaz Nery, Susana PLoS Negl Trop Dis Research Article Preventive chemotherapy (PC), consisting of the regular distribution of anthelmintics to populations or groups of populations at risk, is the primary tool used to control soil-transmitted helminth (STH) infections. This strategy, whilst cost-effective, raises the concern of potential emergence of drug resistance. The efficacy of anthelmintics against STH infections is measured using cure rate (CR) and egg reduction rate (ERR), using microscopy-based techniques such as the Kato-Katz thick smear. However, Kato-Katz has low sensitivity, especially for low-intensity infections, and requires fresh samples that need to be processed quickly. Realtime quantitative PCR (qPCR), which is more sensitive, is emerging as a “gold standard” for STH diagnostics given its higher sensitivity (important in low prevalence settings) and ability to differentiate hookworm species, while sodium nitrate flotation (SNF) may provide a low-cost more sensitive and practical alternative to Kato-Katz in the field. In this study, we examined the efficacy of a locally manufactured brand of albendazole 400 mg (“Alzental”) against hookworm in Đắk Lắk province, Vietnam, using both qPCR and SNF. For qPCR, formulae to convert qPCR cycle threshold (Ct) values into eggs per gram of faeces (EPG) were utilised to determine efficacy calculations, and these values directly compared with efficacy values generated using SNF. Factors associated with CR and ERR were examined, and Alzental tablet quality was assessed by comparing with an Australian TGA-approved equivalent “Eskazole” tablet. We observed a CR and ERR of 64.9% and 87.5% respectively using qPCR, and 68.4% and 67.6% respectively using SNF. The tablet composition of Alzental was comparable to Eskazole in terms of active albendazole drug concentration with no evidence of impurities. This study demonstrates that the efficacy of Alzental against hookworm is within the range of previously reported studies for albendazole 400 mg. The study also demonstrates the value of qPCR and SNF as alternatives to standard Kato-Katz methodology for assessment of anthelmintic efficacy. Public Library of Science 2022-10-31 /pmc/articles/PMC9668116/ /pubmed/36315591 http://dx.doi.org/10.1371/journal.pntd.0010767 Text en © 2022 Dyer et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Dyer, Clare E. F.
Clarke, Naomi E.
Nguyen, Dinh Ng
Herath, H. M. P. Dilrukshi
Hii, Sze Fui
Pickford, Russell
Traub, Rebecca J.
Vaz Nery, Susana
Assessing the efficacy of albendazole against hookworm in Vietnam using quantitative PCR and sodium nitrate flotation
title Assessing the efficacy of albendazole against hookworm in Vietnam using quantitative PCR and sodium nitrate flotation
title_full Assessing the efficacy of albendazole against hookworm in Vietnam using quantitative PCR and sodium nitrate flotation
title_fullStr Assessing the efficacy of albendazole against hookworm in Vietnam using quantitative PCR and sodium nitrate flotation
title_full_unstemmed Assessing the efficacy of albendazole against hookworm in Vietnam using quantitative PCR and sodium nitrate flotation
title_short Assessing the efficacy of albendazole against hookworm in Vietnam using quantitative PCR and sodium nitrate flotation
title_sort assessing the efficacy of albendazole against hookworm in vietnam using quantitative pcr and sodium nitrate flotation
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9668116/
https://www.ncbi.nlm.nih.gov/pubmed/36315591
http://dx.doi.org/10.1371/journal.pntd.0010767
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