Perbandingan Efektivitasalbendazole 400 Mg Tiga Hari Berturut dan Satu Hari Terhadap Trichuriasis

Abstract

Background. Trichuris trichiura is one of the most common soil-transmitted helminths that infected school age children. Single dose albendazole showed wide variation in of cure and egg reduction rate. Some studies found repeated dose of albendazole would increase its effectiveness. Objective. To determine the effectiveness of 400 mg albendazole three consecutive days compare to 400 mg albendazole single dose against trichiuriasis. Methods. A randomized, open trial was conducted in May and June 2009 among elementary school children at Karo Municipal, North Sumatera Province. Stool samples were collected before treatment and on day 7,14, 21, and 28 after treatment using the Kato Katz method. Group I received 400 mg albendazole three consecutive days and group II received 400 mg albendazole single dose. Cure rate and egg reduction rate were compared using Chi-square and Wilcoxon rak sum test respectively. Result. Two hundred and sixty subjects enrolled in this study (group I n= 118, group II n=142). The prevalence of trichuriasis was 54.7% which 70.6% of them were co-infected with Ascaris lumbricoides. Cure rate of 400 mg albendazole three consecutive days was statistically significant higher on day 7 and 14 (83.9% and 64.8%, P=0.0001; 96.6% and 88.7%, P=0.013, respectively). Intensity of infection is correlated with the effectiveness of the regimen used, where longer regimen gave higher cure rate on moderate trichuriasis (50% and 11.1%, P=0.001). On day 7 and 14, egg reduction rates was also statistically better in group I compared to group II (96.8% and 83.7%, P=0.001; 99.7% and 96.3%, P=0.041, respectively). Conclusion. Both regimens have high effectiveness against trichuriasis. Effectiveness is depended on the intensity of infection. On moderate infection, 400 mg albendazole three consecutive days is more effective than single dose regimen. While in light infection, both regimen are equally effective. Keywords: albendazole, trichuriasis, single dose, repeated doses

Latar belakang. Trichuris trichiura adalah salah satu jenis soil-transmitted helmitnhs yang paling banyak menginfeksi anak usia sekolah. Albendazole dosis tunggal menunjukkan angka kesembuhan dan penurunan telur yang bervariasi. Beberapa penelitian mendapatkan regimen albendazole dosid berulang memberikan efektivitas yang lebih baik. Tujuan. Untuk membandingkan efektivitas pemberian albendazole 400 mg 3 hari berturut dan satu hari terhadap trichuriasis. Metode. Uji klinis terbuka terhadap anak-anak usia sekolah dasar dilakukan selama Mei dan Juni 2010, di Kabupaten Karo, Provinsi Sumatera Utara. Sampel tinja diperiksa menggunakan metode Kato-Katz sebelum dan sesudah hari ke 7, 14, 21, dan 28 pemberian obat. Kelompok I mendapatkan terapi albendazole 400 mg selama 3 hari berturut dan kelompok II mendapatkan albendazole 400 mg satu hari. Uji Chi-square dan Wilcoxon rank sum digunakan untuk membandingkan angka kesembuhan dan penurunan telur diantara kedua kelompok. Hasil. Penelitian ini melibatkan 260 subjek (kelompok I n= 118, kelompok II n= 142). Prevalensi trichuriasis didapatkan sebesar 54.6% dengan 70.6% diantaranya berupa infeksi campuran dengan Ascaris lumbricoides. Angka kesembuhan albendazole 400 mg 3 hari berturut secara stastistik lebih tinggi pada hari ke 7 dan 14 (83.9% dan 64.8%, P=0.0001 di hari ke 7, 96.6% dan 88.7%, P=0.013 di hari ke 14). Derajat intensitas infeksi berhubungan dengan efektivitas regimen yang digunakan, regimen 3 hari berturut memberikan angka kesembuhan yang lebih tinggi pada trichuriasis derajat sedang (50% dan 11.1%, P=0.001). Angka penurunan telur di hari ke 7 dan 14 juga lebih tinggi pada kelompok I ( 96.8% dan 83.7%, P=0.001 pada hari ke 7, 99.7% dan 96.3%, P=0.041 pada hari ke 14). Kesimpulan. Albendazole 400 mg tiga hari berturut dan satu hari, menunjukkan efektivitas yang tinggi terhadap infeksi T. trichiura. Perbedaan intensitas infeksi akan mempengaruhi efektivitas. Pada trichuriasis derajat sedang, pemberian regimen albendazole 400 mg 3 hari berturut lebih efektif daripada albendazole 400 mg satu hari, akan tetapi tidak ada perbedaan efektivitas untuk trichuriasis intensitas ringan. Kata kunci: albendazole, trichuriasis, dosis tunggal, dosis berulang