Efficacy of mebendazole and levamisole, alone or in combination, for soil-transmitted helminthiasis

Main Article Content

Ifo Faujiah Sihite
Muhammad Ali
Ayodhia P. Pasaribu
Syahril Pasaribu
Chairuddin P. Lubis



The World Health Organization (WHO) recommends four, single-dose drugs (albendazole, levamisole, mebendazole, and pyrantel pamoate) for management of soil­transmitted helminthiasis (STH). Previous studies have shown varied and inconsistent outcomes of these STH treatments.


To compare the efficacy of mebendazole and levami­sole, alone or in combination, for the treatment of STH.


An open randomized controlled trial was conducted in Secanggang, North Sumatera from August to October 2009. School-aged children with STH infection were randomized into three groups. Group I received a single dose of mebendazole (500 mg); group II received a single dose of levamisole (2.5 mg/kg); and group III received a single dose of mebendazole-levamisole combined. Stool samples were collected at baseline, and the 1st, 2nd, 3rd, and 4th weeks after treatment and examined by the Kato-Katz technique. Statistical analyses were Kruskal-Wallis test for cure rate and Analysis of Variance (ANOVA) test for egg reduction rate.


STH was diagnosed in 197 children with the following parasite species: Ascariasis (96 children, 48.7%), Trichuriasis (58 children, 29.4%), and mixed infection (43 children, 21.8%). We found no hookworm infection in any of our subjects. Groups I and III had significantly higher efficacy (P=0.0001) against STH (egg reduction rate 99.3% and 99.9%; cure rate 92.2% and 98.4%, respectively) at 4th week of treatment.


A single dose of mebendazole alone and combined with levamisole have better efficacy compared to a single dose of levamisole for the treatment of STH. The highest efficacy of these treatments is noted at the 4th week after drug administration

Article Details

How to Cite
Sihite I, Ali M, Pasaribu A, Pasaribu S, Lubis C. Efficacy of mebendazole and levamisole, alone or in combination, for soil-transmitted helminthiasis. PI [Internet]. 28Feb.2014 [cited 22Nov.2019];54(1):9-4. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/161
Received 2016-08-15
Accepted 2016-08-15
Published 2014-02-28


1. Bethany J, Brooker S, Albonico M, Geiger SM, Loukas A, Diemert D, et al. Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet. 2006;367: 1521-32.
2. Montresor A, Crompton DWT, Gyorkos TW, Savioli L Helminth control in school-age children. Geneva: WHO; 2002. p. 1-24.
3. Awasthi S, Bundy DAP, Savioli L Helminthic infections. BMJ. 2003;327:431-3.
4. Hotez PJ, Silva N, Brooker S, Bethany J. Soil transmitted helminth infection: the nature, causes and burden of the condition. Working Paper No 3, Disease Control Priorities Project. Maryland: Fogarty International Center, National Institutes of Health; 2003. p. 1-7
5. Keiser J, Utzinger J. Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis. JAMA 2008;299:1937-48.
6. M Mardiana, D Djarismawati. Prevalensi cacing usus pada murid sekolah dasar wajib belajar pelayanan gerakan terpadu pengentasan kemiskinan daerah kumuh di wilayah DKI Jakarta. Jumal Ekologi Kesehatan. 2008;7:769-74.
7. Firmansyah I, Ginting SA, Lu bis M, Lubis IZ, Pasaribu S, Lubis CP. Factor associated with the transmission of soil­transmitted helminthiasis among schoolchildren. Paediatr Indones. 2004;44:127-32.
8. Albonico M, Bickle Q, Ramsan M, Montresor A, Savioli L, Taylor M. Efficacy of mebendazole and levamisole alone or in combination against intestinal nematode infections after repeated targeted mebendazole treatment in Zanzibar. Bull World Health Org. 2003;81:343-52.
9. Albonico M, Bickle Q, Haji HJ, Ramsan M, Khatib KJ, Montresor A, et al. Evaluation of the efficacy of pyrantel­oxantel for the treatment of soil-transmitted nematode infections. Trans R Soc Trop Med Hyg. 2002;96:685-90.
10. Syarif A, Elysabeth. Antelmintik. In: Gunawan SG, Setiabudy R, Nafrialdi, Elysabeth, editors. Farmakologi dan terapi. 5th ed. Jakarta: Gaya Baru; 2007. p. 541-4.
11. Zaman V. Nematoda. In: Anwar C, Mursal Y, editors. Atlas parasitologi kedokteran. Jakarta: Hipokrates; 1997. p. 174- 233.
12. Askariasis (infeksi cacing gelang). In: Soedarmo SSP, Gama H, Hadinegoro SRS, Satari HI editors. Buku ajar infeksi dan penyakit tropis pediatti. Jakarta: BP IDAI; 2008. p. 3 71-5.
13. Flohr C, Tuyen LN, Lewis S, Minh TT, Campbell J, Briton J, et al. Low efficacy of mebendazole against hookworm in Vietnam: two randomized controlled trials. Am J Trop Med Hyg. 2007;76:732-6.
14. The partnership for child development. Cost of school-based drug treatment in Tanzania. Health Policy and Planning. 1998;13:384-96.
15. Albonico M, Ivo de ceneri F. Treatment of soil-transmitted helminth infection: prescribing information for disease control. In: Crompton DWT, Montresor A, Nesheim MC, Savioli L, editors. Controlling disease due to helminth infections. Geneva: WHO; 2003. p. 109-126.
16. Montresor A, Crompton DWT, Hall A, Bundy DAP, Savioli L In: Guidelines for the evaluation of soil-transmitted helminthiasis and schistosomiasis at community level. Geneva: WHO; 1998. p. 3-49.
17. Albonico M, Allen H, Chitsulo L, Engels D, Gabrielli AF, Savioli L Controlling soil-transmitted helminthiasis in pre­school-age children through preventive chemotherapy. PloS Negl Trop Dis. 2008;2:1-11.
18. Working group on soil-transmitted helminthiasis. Monitoring anthelmintic efficacy for soil transmitted helminths (STH). Geneva: WHO; 2008. p.1,41.
19. World Health Organtization. Schistosomiasis and Intestital Parasites Unit Division of Control of Tropical Diseases. Report of the WHO informal consultation on the use of chemotherapy for the control of morbidity due to soil, transmitted nematodes in human. Geneva: WHO; 1996. p. 12-22.
20. Reddy M, Gill SS, Kalkar SR, Wu W, Anderson PJ, Rochon PA. Oral drug therapy for multiple neglected tropical diseases: a systematic review. JAMA. 2007 ;298: 1911-24.