Antonio Ayrton Widiastara, Amalia Margaretha Lucas, Laura Boavida da Gama, Basiraldo Baru Guterres, Esmeraldito Ferreira, Sergio Herminio Gomes Fernandes

Emerging Resistance to Albendazole in Soil-Transmitted Helminths

Introduction

Emerging resistance to albendazole in soil-transmitted helminths. Emerging resistance to albendazole in soil-transmitted helminths (STHs) is a global concern. This review highlights declining drug efficacy & the urgent need for monitoring and new intervention strategies.

Abstract

Soil-transmitted helminths (STHs) are significant pathogens affecting approximately 1.5 billion people globally, with the highest prevalence in sub-Saharan Africa, South America, and Asia. This study examined the effectiveness of albendazole, a widely used anthelminthic drug, in treating STH infections, particularly focusing on its potential resistance. Despite its effectiveness in many cases, recent studies have indicated a concerning trend of reduced efficacy, particularly against species such as Trichuris trichiura. This study reviewed literature from the past decade, identifying key studies that demonstrate a decline in albendazole’s effectiveness across various populations, including school-aged children in multiple regions. The findings proposed that while albendazole remains the primary treatment option, its effectiveness varies significantly based on geographic and demographic factors, raising concerns about the emergence of drug resistance. This study emphasizes the need for ongoing monitoring and potential pharmacological combinations to enhance treatment efficacy and address the threat of resistance. Ultimately, the research highlights the complexity of managing STH infections and the necessity for tailored intervention strategies. Highlights: 1. Although albendazole is a commonly used medication for soil-transmitted helminths (STHs), its efficacy seems to be waning, thereby requiring additional research to analyze potential resistance. 2. Many studies have pointed out a decreased efficacy of albendazole, despite none having verified resistance, indicating that the medication remains efficacious in specific groups, geographical areas, and dosage regimens where STH infections are prevalent.

Review

This review effectively highlights a critical and concerning trend in global public health: the potential emergence of resistance to albendazole in soil-transmitted helminths (STHs). Given that STHs afflict an estimated 1.5 billion people worldwide and albendazole is a cornerstone of their treatment, any reduction in its efficacy carries significant implications for disease control efforts. The study positions itself as a timely literature review, synthesizing a decade of research to explore the observed decline in albendazole's effectiveness across various populations and geographical regions, particularly noting challenges against *Trichuris trichiura*. The abstract clearly articulates the central dilemma: while albendazole remains a primary treatment, its effectiveness is demonstrably waning in certain contexts. The review points to a "concerning trend of reduced efficacy," yet the provided highlights introduce a crucial nuance, noting that "none having verified resistance" despite numerous studies indicating decreased efficacy. This distinction is vital; it suggests an observation of reduced clinical effectiveness that *points* to potential resistance, rather than conclusive, genetically confirmed drug resistance. This nuanced finding underscores the complexity of the issue, indicating that efficacy varies significantly based on factors such as geography, demography (e.g., school-aged children), and potentially specific helminth species. Ultimately, this literature review serves as an important call to action, emphasizing the urgent need for ongoing surveillance and monitoring of albendazole efficacy globally. The authors' recommendation for potential pharmacological combinations and tailored intervention strategies is well-justified given the reported variability in drug performance. By compiling evidence of reduced efficacy and the potential for emerging resistance, the study reinforces the complexity of STH control and provides a strong argument for proactive research into alternative treatments, resistance mechanisms, and optimized treatment regimens to safeguard the effectiveness of current anthelminthic strategies.

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