Albendazole: Clinical Evidence & Trials

Evidence Strength

Level A (Strong) for soil-transmitted helminthiasis (ascariasis, enterobiasis, trichuriasis); Level B for echinococcosis and neurocysticercosis (combined with praziquantel/corticosteroids).

Key Clinical Trial Findings

• •WHO MDA programmes — albendazole/mebendazole mass drug administration in school-age children achieves >90% cure rates for Ascaris, >85% for hookworm
• •Cochrane review (Taylor-Robinson 2019) — single-dose albendazole vs placebo: cure rate 97% for Ascaris lumbricoides, ~88% for hookworm
• •Echinococcosis — PAIR (puncture-aspiration-injection-reaspiration) + albendazole superior to surgery alone; albendazole reduces cyst recurrence (NEJM 2000 WHO trial)
• •Neurocysticercosis — cysticidal albendazole + dexamethasone reduces seizure recurrence (Del Brutto Cochrane 2014; Lancet Neurology meta-analysis)
• •Enterobiasis — single-dose mebendazole 100mg or albendazole 400mg: >95% cure rate; family treatment recommended

Numbers Needed to Treat (NNT)

Ascariasis (single dose): NNT ≈ 1.1 for parasite clearance. Echinococcosis (adjuvant to PAIR): NNT ≈ 3 for recurrence prevention. Preventive chemotherapy in endemic school children: NNT ≈ 6 for anaemia prevention.

Guideline Recommendations

WHO Essential Medicines List: both albendazole and mebendazole included. WHO recommends annual/biannual MDA for STH in endemic areas. NICE: mebendazole first-line for threadworm in UK. CDC: albendazole first-line for echinococcosis, neurocysticercosis, and alternative for giardiasis.