Drug Resistance to Be Avoided
July 17, 2008 – 12:28 pm
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As yet there is no confirmed report of anthelmintic drug resistance in a soil-transmitted nematode infection in humans. However, resistance to benzimidazoles, levamisole, and, to a lesser extent, avermectins, are commonly reported in the veterinary literature. Thus, there is understandable concern that this problem may threaten the use of anthelmintic drugs for the control of soil-transmitted nematodes in humans.
Chemotherapy should be used in such a way that the emergence of drug resistance is delayed or circumvented, while health benefits continue to accrue. Factors that can act against the development of drug resistance include.
* treatment of only a proportion of the population in an infected community (e.g. targeting school children), which will ensure that some nematodes remain in the community and that the genes of these survivors will dilute those of the nematodes experiencing selection pressure
* giving treatment at intervals greater than those of the nematode’s generation time
* changing the drug of choice for a particular control program.
At the same time, development of a protocol for the detection of suspected drug resistance, e.g. fecal egg count reduction tests, would be prudent.