A review: Updates on the treatment and integrated control strategies to eliminate Trichuris trichiura

Authors

Keywords:

Trichuris trichiura, treatment;, integrated control., soil-transmitted helminths

Abstract

Current treatment of Trichuris trichiura infection predominantly relies on benzimidazole derivatives, namely albendazole and mebendazole. However, emerging evidence of suboptimal efficacy and potential drug resistance has prompted the investigation of alternative therapeutic approaches. Recent clinical trials have demonstrated enhanced efficacy through novel drug combinations, including albendazole co-administered with ivermectin or oxantel pamoate. In parallel, integrated control strategies encompassing mass drug administration (MDA), water, sanitation, and hygiene (WASH) interventions, and vaccine development are gaining attention as sustainable solutions to reduce transmission and reinfection rates. This review synthesizes recent advances in pharmacological and public health interventions, highlighting the need for multifaceted approaches to effectively combat T. trichiura infections.

Author Biographies

  • Wu Yanming, Institute for Research in Molecular Medicine (INFORMM)
    INFORMM-1
  • Nurulhasanah Othman, Universiti Sains Malaysia
    INFORMM-1

References

Welsche S, Mrimi EC, Hattendorf J, Hürlimann E, Ali SM, Keiser J. Efficacy and safety of moxidectin and albendazole compared with ivermectin and albendazole coadministration in adolescents infected with Trichuris trichiura in Tanzania: an open-label, non-inferiority, randomised, controlled, phase 2/3 trial. The Lancet Infectious Diseases 2023;23:331–40. https://doi.org/10.1016/S1473-3099(22)00589-8.

Matamoros G, Sánchez A, Gabrie JA, Juárez M, Ceballos L, Escalada A, et al. Efficacy and Safety of Albendazole and High-Dose Ivermectin Coadministration in School-Aged Children Infected With Trichuris trichiura in Honduras: A Randomized Controlled Trial. Clin Infect Dis 2021;73:1203–10. https://doi.org/10.1093/cid/ciab365.

Steinmann P, Utzinger J, Du Z-W, Jiang J-Y, Chen J-X, Hattendorf J, et al. Efficacy of single-dose and triple-dose albendazole and mebendazole against soil-transmitted helminths and Taenia spp.: a randomized controlled trial. PLoS One 2011;6:e25003. https://doi.org/10.1371/journal.pone.0025003.

Keiser J, Utzinger J. Efficacy of Current Drugs Against Soil-Transmitted Helminth Infections: Systematic Review and Meta-analysis. JAMA 2008;299:1937–48. https://doi.org/10.1001/jama.299.16.1937.

Lloyd AE, Honey BL, John BM, Condren M. Treatment Options and Considerations for Intestinal Helminthic Infections. J Pharm Technol 2014;30:130–9. https://doi.org/10.1177/8755122514533667.

Viswanath A, Yarrarapu SNS, Williams M. Trichuris trichiura Infection. StatPearls, Treasure Island (FL): StatPearls Publishing; 2025.

Buonfrate D. Alternative treatment strategies for trichuriasis. The Lancet Infectious Diseases 2023;23:266–7. https://doi.org/10.1016/S1473-3099(22)00653-3.

Moncayo AL, Vaca M, Amorim L, Rodriguez A, Erazo S, Oviedo G, et al. Impact of Long-Term Treatment with Ivermectin on the Prevalence and Intensity of Soil-Transmitted Helminth Infections. PLoS Negl Trop Dis 2008;2:e293. https://doi.org/10.1371/journal.pntd.0000293.

Moser W, Schindler C, Keiser J. Efficacy of recommended drugs against soil transmitted helminths: systematic review and network meta-analysis. BMJ (Clinical Research Ed) 2017;385:j4307. https://doi.org/10.1136/bmj.j4307.

Gebreyesus TD, Makonnen E, Tadele T, Mekete K, Gashaw H, Gerba H, et al. Reduced efficacy of single-dose albendazole against Ascaris lumbricoides, and Trichuris trichiura, and high reinfection rate after cure among school children in southern Ethiopia: a prospective cohort study. Infect Dis Poverty 2024;13:8. https://doi.org/10.1186/s40249-024-01176-6.

Elard L, Humbert JF. Importance of the mutation of amino acid 200 of the isotype 1 β- tubulin gene in the benzimidazole resistance of the small-ruminant parasite Teladorsagia circumcincta. Parasitology Research 1999;85:452–6. https://doi.org/10.1007/s004360050577.

Ghisi M, Kaminsky R, Mäser P. Phenotyping and genotyping of Haemonchus contortus isolates reveals a new putative candidate mutation for benzimidazole resistance in nematodes. Veterinary Parasitology 2007;144:313–20. https://doi.org/10.1016/j.vetpar.2006.10.003.

Su Q, Baker L, Emery S, Balan B, Ansell B, Tichkule S, et al. Transcriptomic analysis of albendazole resistance in human diarrheal parasite Giardia duodenalis. International Journal for Parasitology: Drugs and Drug Resistance 2023;22:9–19. https://doi.org/10.1016/j.ijpddr.2023.03.004.

Gandasegui J, Grau-Pujol B, Novela V, Muchisse O, Cambra-Pellejà M, Cossa A, et al. Deep-amplicon sequencing of the complete beta-tubulin gene in Trichuris trichiura before and after albendazole treatment. International Journal for Parasitology: Drugs and Drug Resistance 2024;26:100570. https://doi.org/10.1016/j.ijpddr.2024.100570.

Speich B, Ali SM, Ame SM, Bogoch II, Alles R, Huwyler J, et al. Efficacy and safety of albendazole plus ivermectin, albendazole plus mebendazole, albendazole plus oxantel pamoate, and mebendazole alone against Trichuris trichiura and concomitant soil-transmitted helminth infections: a four-arm, randomised controlled trial. The Lancet Infectious Diseases 2015;15:277–84. https://doi.org/10.1016/S1473-3099(14)71050-3.

Speich B, Ame S, Ali S, Alles R, Huwyler J, Hattendorf J, et al. Oxantel pamoate-albendazole for Trichuris trichiura infection. The New England Journal of Medicine 2014. https://doi.org/10.1056/NEJMoa1301956.

Palmeirim MS, Hürlimann E, Beinamaryo P, Kyarisiima H, Nabatte B, Hattendorf J, et al. Efficacy and safety of albendazole alone versus albendazole in combination with ivermectin for the treatment of Trichuris trichiura infections: An open-label, randomized controlled superiority trial in south-western Uganda. PLOS Neglected Tropical Diseases 2024;18:e0012687. https://doi.org/10.1371/journal.pntd.0012687.

Krolewiecki A, Kepha S, Fleitas PE, van Lieshout L, Gelaye W, Messa A, et al. Albendazole–ivermectin co-formulation for the treatment of Trichuris trichiura and other soil-transmitted helminths: a randomised phase 2/3 trial. The Lancet Infectious Diseases 2025;25:548–59. https://doi.org/10.1016/S1473-3099(24)00669-8.

Abene S. CHMP Approves Ivermectin/Albendazole Combination for Parasitic Worm Infections. ContagionLive 2025.

Vaz Nery S, Pickering AJ, Abate E, Asmare A, Barrett L, Benjamin-Chung J, et al. The role of water, sanitation and hygiene interventions in reducing soil-transmitted helminths: interpreting the evidence and identifying next steps. Parasit Vectors 2019;12:273. https://doi.org/10.1186/s13071-019-3532-6.

Makaula P, Kayuni SA, Mamba KC, Bongololo G, Funsanani M, Musaya J, et al. An assessment of implementation and effectiveness of mass drug administration for prevention and control of schistosomiasis and soil-transmitted helminths in selected southern Malawi districts. BMC Health Serv Res 2022;22:517. https://doi.org/10.1186/s12913-022-07925-3.

Sahimin N, Abu Bakar N, Lim YAL, Behnke JM, Lewis J, Kamaruddin N, et al. Entry of Migrant Workers to Malaysia: Consideration to Implement Mass Drug Administration Against Intestinal Parasitic Infections. Int J Health Policy Manag 2024;13:7842. https://doi.org/10.34172/ijhpm.2024.7842.

Else KJ, Keiser J, Holland CV, Grencis RK, Sattelle DB, Fujiwara RT, et al. Whipworm and roundworm infections. Nat Rev Dis Primers 2020;6:1–23. https://doi.org/10.1038/s41572-020-0171-3.

Ali J, Polland A, Adlerstein D, Gziabher YG, Sabar G, Liss Y, et al. Deworming school children in Ethiopia: The importance of a comprehensive approach. Open Journal of Tropical Medicine 2018;3:001–6. https://doi.org/10.17352/ojtm.000008.

Hayon J, Weatherhead J, Hotez PJ, Bottazzi ME, Zhan B. Advances in vaccine development for human trichuriasis. Parasitology 2021;148:1783–94. https://doi.org/10.1017/S0031182021000500.

Wei J, Hegde VL, Yanamandra AV, O’Hara MP, Keegan B, Jones KM, et al. Mucosal Vaccination With Recombinant Tm-WAP49 Protein Induces Protective Humoral and Cellular Immunity Against Experimental Trichuriasis in AKR Mice. Front Immunol 2022;13. https://doi.org/10.3389/fimmu.2022.800295.

Welsche S, Mrimi E, Hattendorf J, Hürlimann E, Ali SM, Keiser J. Efficacy and Safety of Moxidectin and Albendazole Compared to Ivermectin and Albendazole Co-Administration in Adolescents Infected with Trichuris Trichiura: A Randomized Controlled Non-Inferiority Phase II/III Trial 2022. https://doi.org/10.2139/ssrn.4168899.

Barda B, Ame SM, Ali SM, Albonico M, Puchkov M, Huwyler J, et al. Efficacy and tolerability of moxidectin alone and in co-administration with albendazole and tribendimidine versus albendazole plus oxantel pamoate against Trichuris trichiura infections: a randomised, non-inferiority, single-blind trial. The Lancet Infectious Diseases 2018;18:864–73. https://doi.org/10.1016/S1473-3099(18)30233-0.

Downloads

Published

2026-02-27

Issue

Section

Journal of Biomedical and Clinical Sciences