Oral drug therapy for multiple neglected tropical diseases: a systematic review.

[dracunculiasis]

The neglected tropical diseases include 13 conditions that occur in areas of extreme poverty and are poverty promoting . The neglected tropical diseases produce a disease burden almost as great as that associated with human immunodeficiency virus /AIDS , tuberculosis , or malaria , yet are virtually unknown by health care workers in North America , because they occur almost exclusively in the poorest regions of the world . Seven of the most prevalent diseases have existing oral drug treatments . Identifying treatments that are effective against more than 1 disease could facilitate efficient and inexpensive treatment .To systematically review the evidence for drug treatments and to increase awareness that neglected tropical diseases exist and that treatments are available .Using a MEDLINE search (1966 through June 2007 ), randomized controlled trials (RCTs ) were reviewed that examined simultaneous treatment of 2 or more of the 7 most prevalent neglected tropical diseases using oral drug therapy .Twenty -nine RCTs were identified , of which 3 targeted 4 diseases simultaneously , 20 targeted 3 diseases , and 6 targeted 2 diseases . Trials were published between 1972 and 2005 and baseline prevalence of individual diseases varied among RCTs . Albendazole plus diethylcarbamazine significantly reduced prevalence of elephantiasis (16 .7 % to 5 .3 %), hookworm (10 .3 % to 1 .9 %), roundworm (34 .5 % to 2 .3 %), and whipworm (55 .5 % to 40 .3 %). Albendazole plus ivermectin significantly reduced prevalence of elephantiasis (12 .6 % to 4 .6 %), hookworm (7 .8 % to 0 %), roundworm (33 .5 % to 6 .1 %), and whipworm (42 .7 % to 8 .9 %). Levamisole plus mebendazole significantly reduced prevalence of hookworm (94 .0 % to 71 .8 %), roundworm (62 .0 % to 1 .4 %), and whipworm (93 .1 % to 74 .5 %). Pyrantel-oxantel significantly reduced hookworm (93 .4 % to 85 .2 %), roundworm (22 .8 % to 1 .4 %), and whipworm (86 .8 % to 59 .5 %), while albendazole alone significantly reduced prevalence of hookworm (8 .1 % to 1 .3 %), roundworm (28 .4 % to 0 .9 %), and whipworm (51 .9 % to 31 .9 %). No RCT examined treatment of river blindness or trachoma as part of an intervention to target 2 or more neglected tropical diseases . Adverse events were generally inadequately reported .At least 2 of the most prevalent neglected tropical diseases can be treated simultaneously with existing oral drug treatments , facilitating effective and efficient treatment . Increasing awareness about neglected tropical diseases , their global impact , and the availability of oral drug treatments is an essential step in controlling these diseases .

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