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A Trial of Oxantel in Trichuriasis

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A Trial of Oxantel in Trichuriasis Vol. 17, No. 4. SINGAPORE MEDICAL JOURNAL 219 December. 1976. A TRIAL OF OXANTEL IN TRICHURIASIS By Freda M. Paul and V. Zaman SYNOPSIS In this study we are reporting on the efficacy of Oxantel in eight Trichuriasis children admitted into the Paediatric Unit, Singapore General Hospital with gastrointestinal symptoms, protein caloric malnutrition and nutritional anaemia. Detailed case history is given of each of these cases to show their socio -economie background. Oxantel was administered in the form of a suspension given in a dose of 10 mgm per kilogram body weight twice a day usually for four days. Stool examination was conducted once before treatment and for consecutive days after treatment. This was followed whenever possible by one stool examination two weeks later and another after 3 months. The response to Oxantel was judged by its ability to relieve gastrointestinal symptoms such as diarrhoea, and decrease the ova count in the faeces. Oxantel was well tolerated by all patients and none of them showed any adverse reaction to the drug, which did not alter the morphology of the ova that was passed in the faeces. In one of the patients parasites re- appeared after a complete cure. This was certainly a case of re -infection, and indicates the importance of environmental sanitation in keeping the population free of intestinal helminthiasis. INTRODUCTION MATERIAL AND METHODS The most common intestinal helminth found in Oxantel was administered in the form of a Singapore and Malaysia is Trichuris trichiura suspension given in a dose of 10 mg/kg body weight (Desowitz et al, 1961; Lie, 1964). In a survey done in twice a day, usually for four days. Stool examina- the Singapore General Hospital 38% of the children tion was conducted once before treatment and for were found to be infected with Trichuris with the four consecutive days after treatment. This was highest prevalence rates amongst Malays, followed followed whenever possible by one stool examina- by Indians and the Chinese (Kan et al, 1971). tion 2 weeks later and another after 3 months. The technique of examination was that of an ordinary Chemotherapy of trichuriasis has been unsatis- direct smear using 2 mgm of faeces, according to until recently. Dithiazanine iodide which is factory Beaver's method (1950). an effective trichuricide is no longer used because of its serious side effects. Case 1 Recently, two anti-Trichuris drugs have been in- girl troduced; they are Mebendazole and Oxantel (Trans - Z.B.M.Y. was a 5-yéar old Malay and 1, 4, 5, 6 tetrahydro-2- (trans-3-hydroxystyryl)-1- admitted because of fever and reproductive cough of methyl pyrimidine (CP-14-445). In a previous study 8 days duration and was referred from a rural infant Mebendazole was shown by us to be an effective welfare clinic at Bedok. There was a past history of drug against this parasite (Paul and Zaman, 1975). diarrhoea for which the child had been treated In the present study we are reporting on the efficacy symptomatically at the infant welfare clinic. The eldest of Oxantel in 8 trichuriasis cases admitted into the child was the youngest of 10 children, the Paediatric Unit, Singapore General Hospital with being 20 years. The father earned only $100/- a gastro intestinal symptoms, protein -caloric month, as an odd job labourer, and he belonged to malnutrition and nutritional anaemia. Detailed case the lower income group. This child had been history is given of each of these cases to show their followed up regularly at the maternal and child socio-economic background. -, welfare clinic and although the initial weight at birth was normal, the weight gain was slow and she was at most times along the 25th percentile in weight. Physical examination revealed a height of 101 cm Department of Paediatrics, University of Singapore. and a weight of 13.4 kg, being 10th and 25th FREDA M. PAUL, percentile respectively, using Singapore standards. Associate Professor. She was malnourished and febrile with an injected Department of Parasitology, University of Singapore. throat and tonsils. There were also signs of V. ZAMAN, Ph.D., DSc, pneumonitis on the left side with diminished air Professor. entry and adventitious sounds. Blood examination 220 SINGAPORE MEDICAL JOURNAL showed a haemoglobin of 8.2 gm%a, a total white were giant myelocytes and megoloblasts as well. The cell count of 15,700 cm with polymorphs 67%, serum albumin was low being only 2.9 gm% while lymphocytes 17%, monocytes 3% and eosinophils the serum folic acid was also low being 2.0 ngm%. 13%. Platelet count was 690,090 cmm. Serum The culture of the stools did not reveal any protein showed a normal albumin globulin ratio 4.0 Salmonella, Mycelia or pathogenic E. coli but a gm% to 3.6 gm% respectively. Serum iron was 35 direct smear showed the presence of Ascaris and micrograms Wo and folic acid 25.0 ng/ml. The Trichuris ova. culture of the throat swab grew coliform organisms The child was put on a course of Ampicillin and with candida species. A radiograph of the chest Cloxacillin to clear the chest infection and she did the presence of consolidation of the left showed well. Examination of the stools revealed 60 Ascaris lung. Examination of the faeces showed the presence ova per 2 mgm and 7 Trichuris ova per 2 mgm of of Trichuris ova. The child was given a course of stool. The results of treatment with Oxantel were as Ampicillin and Cloxacillin for the chest infection follows:- and Oxantel for trichuriasis. The results of treatment with Oxantel were as follows:- Dosage of Date Ova Count Oxantel Dosage of Date Ova Count Oxantel 21.3.75 7 per 2 mgm Nil 22.3.75 7 per 2 mgm 10 mg/kg bd 6.3.75 248 per2mgm 10 mg/kgbd 23.3.75 4 per 2 mgm 10 mg/kg bd 189 2 10 7.3.75 per mgm mg/kg bd 26.3.75 0 per 2 mgm 10 mg/kg bd 8.3.75 68 per 2 mgm 10 mg/kg bd 27.3.75 0 per 2 mgm 10 mg/kg bd 9.3.75 Not done 10 mg/kg bd 10.3.75 21 per 2 mgm Nil was the roundworm 11.3.75 2per2mgm Nil In addition Piperazine given -for 13.3.75 0 per 2 mgm Nil infestation. Examination of the stool on 2.12.75 did not show The child was sent to a convalescent home at Chang' evidence of any ova. On her last check-up date on on 13.3.75 and she put on 2 kg in 31/2 months at the 30.3.75 she had grown by 7 cm and measured 107 home. The stools were examined at the end of cm, which was at the 10th percentile and weighed November 1975 and they showed no evidence of any 15.6 kg which was at the 10th percentile, using ova. In November 1975 the child was 17.5 kg (75th Singapore standards. The haemoglobin had risen to percentile) and measured 108 cm (50th percentile), 11.7 gm%. The Trichuris infestation in this child using Singapore standards. This showed that the was light and cleared within 2 days of treatment. child was cleared of trichuriasis infestation and had improved nutritionally. Case 3 P.E.T. was a 9 -year old Chinese child admitted Case 2 for an established rheumatic carditis with sub- cutaneous nodules. The history dated 15 days ago N.S.H. was an 8 -year old girl living in Jurong in when the child had fever with prominent nodules a rural area hut, admitted because of postmeasles over bony prominences, proximal interphalangeal bronchopneumonia. In addition, there was a history joints, and vertebral column, malleolus and fibula. of vomiting roundworms about 2-3 ascarids for the There was no past history of sore throat or past two days and a history of mild diarrhoea. The involuntary movements. In this particular case, child had a cough with nonproductive sputum and there was no past history of diarrhoea but because there was marked anorexia with loss of appetite. The the child came from a rural area of Singapore, a patient was the second in a family of 4 children and routine examination of the stools was done for belonged to the lower income group, the father Trichuris ova. Physical examination revealed a earning $300/- per month. height of 1.7 metres and a weight of 15 kg, both were Physical examination revealed a child who was below the 3rd percentile, using Singapore standards. severely wasted. She weighed 11.7 kg (3rd percentile) He had visible nodules over the occiput, vertebral and measured 99.6 cm (3rd percentile), using column, proximal interphalangeal joints, palmer Singapore standards. There was a postmeasles stain- surface, head of fibula and malleolus. The apex beat ing of the skin and the pharynx was congested. The was in the fourth left intercostal space three inches chest was full of bilateral crepitations. The liver was from the mid -sternal line, and there was a systolic 5 cm below the right costal margin. No abnormality thrill and bruit with a mid diastolic bruit due to could be detected in the other systems. Blood mitral incompetence and stenosis. The pulmonary examination showed a haemoglobin of 9.8 gm%, second sound was loud and fixed. The other systems with total white cell count of 11,200 cmm and a were essentially normal. Blood examination showed platelet count of 590,000 cmm. The serum iron was a haemoglobin of 10.4 gm%a, a total white cell count normal being 125 micrograms% but the bone - of 15,000 cmm with polymorphs 44%, lymphocytes marrow showed depletion of iron stores, and there 32%, monocytes 0% and eosinophils 24%.
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