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Repeated-dose albendazole boosts cure odds 4.47-fold in pediatric soil-transmitted helminthsRepeated doses of albendazole improve treatment for soil-transmitted worms

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Key Takeaway
Consider repeated-dose albendazole for pediatric STH, but interpret mebendazole data cautiously.

This meta-analysis pooled data from randomized clinical trials to assess whether repeated-dose albendazole or mebendazole improves cure rates and egg reduction rates compared with standard single-dose regimens in 1718 children with soil-transmitted helminth infections. The primary outcomes were cure rate (CR) and egg reduction rate (ERR).

Repeated dosing was superior for both outcomes. The pooled odds ratio for cure was 4.47 (95% CI 1.58-12.67), and the mean difference for egg reduction rate was 0.17 (95% CI 0.01-0.32). The authors note that multi-dose albendazole consistently enhances parasite clearance, whereas multi-dose mebendazole shows variable performance and lacks conclusive superiority over single dosing.

Limitations include high heterogeneity for cure rate (I^2 = 92%) and egg reduction rate (I^2 = 87%). The superiority of repeated dosing appears drug-specific, and the mebendazole findings are not definitive. Safety outcomes, follow-up duration, and funding sources were not reported.

In practice, these findings support consideration of repeated-dose albendazole for improved parasite clearance in pediatric soil-transmitted helminth infections, while recognizing that the evidence for mebendazole multi-dose regimens remains uncertain and that heterogeneity limits confidence in the pooled estimates.

How this fits prior evidence

This meta-analysis extends prior coverage of mass drug administration (MDA) strategies for neglected tropical diseases, including integrated MDA for yaws and lymphatic filariasis, by focusing specifically on repeated-dose albendazole or mebendazole for soil-transmitted helminths in children. It provides quantitative estimates of cure and egg reduction benefits, contrasting with earlier reviews that addressed ivermectin MDA for onchocerciasis and hookworm co-infections, where immunological data gaps were noted. The high heterogeneity observed here echoes the need for context-specific approaches highlighted in prior MDA evaluations.

Treating soil-transmitted helminth infections, such as hookworm and Trichuris trichiura, is a major concern for children in many parts of the world. These parasites can cause significant health issues, and finding the most effective way to clear them from the body is vital for pediatric care.

Researchers analyzed data from 1,718 patients to see how different dosing schedules worked. They found that giving repeated doses of albendazole was much more effective at clearing parasites than a single dose. This approach also showed a higher egg reduction rate, which means it was better at reducing the number of eggs the parasites produce.

While the results for albendazole were clear, the findings for mebendazole were less certain. Because of high variation in the data, it is not yet clear if multiple doses of mebendazole perform better than a single dose. Because of these differences, the benefits of repeated dosing depend specifically on which medication is being used.

What this means for you:
Repeated doses of albendazole are more effective at clearing soil-transmitted worms in children than a single dose.

Common questions

Is repeated dosing of albendazole more effective for children?

Yes, the data shows that repeated doses of albendazole are significantly more effective at clearing parasites than a single dose. This method showed a much higher success rate for clearing the infection in children with soil-transmitted worms like hookworm and Trichuris trichiura.

Does mebendazole work better with multiple doses?

The results for mebendazole are not conclusive. Because of high variation in the data, it is currently unclear if multiple doses of mebendazole provide a better outcome than a single dose. The effectiveness of repeated dosing depends on the specific drug being used.

What specific infections does this treatment target?

This treatment focuses on soil-transmitted helminth infections. These include specific types of worms like hookworm and Trichuris trichiura, which are common parasites that can affect the health of children.

Study Details

Study typeMeta analysis
Sample sizen = 1,718
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
Background: Preventive chemotherapy via single-dose benzimidazoles remains the core strategy for soil-transmitted helminth (STH) control. However, single-dose regimens often yield sub-optimal clearance against species such as 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 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; I{superscript 2} = 92%) and egg reduction rate (pooled MD = 0.17, 95% CI: 0.01-0.32; I{superscript 2} = 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.
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