Abstract
Abstract
Background
The 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.
Methods
Registered 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.
Results
Five 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; I² = 92%) and egg reduction rate (pooled MD = 0.17, 95% CI: 0.01–0.32; I² = 87%).
Discussion
Repeated-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.
Conclusion
Transitioning 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 summary
While 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.