ORIGINAL ARTICLES References A COMPARISO OF 1. Haupt H.A., RO\"ere GO. Anabolic steroids- a redew of the literature. Am {Sports Mrd 198-1; 12: -I69-J8.l. MEBENDAZOLE AND 2. \V"tlson JD. Androgen abuse by athletes. Endocr Rn' 1988; 9: 181-199. 3. Elashoff JD, Jacknow AD, Sham SG, Braunstein GO. Effects of anabolic·androgenic steroids ALBENDAZOLE IN TREATING on muscular strength. Ann Intern Med 1991; 115: 387·393. 4. Yesalis CE, Bahrke ~. Anabolic-androgenic steroids - current issues. Sports Med 1995; 19: 32("3-W. CHILDREN WITH TRICHURIS 5. Yesalis CE, Buckley WE, Anderson WA, et al. Athletes' projections of anabolic steroid use. elm Sports Afed 1990; 2: 155-171. TRlCHIURA I FECTIO I 6. Perry HM, Wright 0, Littlepage B:":C. Dying to be big: a fe\,jew of anabolic steroid use. Br I Sport, Med 1992; 26, 259-26I. DURBAN, SOUTH AFRICA 7. Buckley WE, Yesalis eE, Friedl CE, Anderson WA, Strelt Al, Wright lE. Estimated prevalence of anabolic steroid use among male high school seniors. JAMA 1988; 260: 34-l1-J.4..t5. 8. Windsor K Dumitru D. Prevalence of anabolic steroid use by male and female adolescents. Med Sci Sports Exn" 1989; 21: 494-197. TFHG Jackson, SR Epstein, E Gouws, RF Cheetham 9. Tanner SM, Miller DW, Alongi C. Anabolic steroid use by adolescents: prevalence, motives, and knowledge of risks. CIin / Sport Mtd 1995; 5: 1 115. 10. Melia P, Pipe A, Greenberg L The use of anabolic·androgenic steroids by Canadian tudents. Clm I Sport Med 1996; 6, 9-H. 11. Korkia P. Anabolic steroid use in adolescents. Sports Ext7Cise and InJury 1996; 2.: 136-1 Objective. To compare the efficacy of mebendazole 500 mg 12. Hickson RC, Ball KL .. Falduto MT. Adverse effects of anabolic steroids. Med Toxieol Adt't'TSf and aIbendazole 400 mg single-close treatments of Trichuris Drug Exp 1989; 4, 254-271. 13. Goldberg L. Adverse effects of anabolic steroids. lAMA 1996; 276, 257. trichiura infection in children in the Durban area of KwaZulu- 14. Johnson M, Jay ~,Shoup B, Rickert V. Anabolic steroid use in adolescent males. Pediatrics atal, South Africa. 1989; 83: 921-92-1. 15. Bumett KF, Kleinman ME. Psychological characteristics of adolescent steroid users. Design. A single-blind randomised trial in children with a Adolescence 1994; 29: 81-89. 16. DuRant RH. Rickert VI. Ashworth CS. !':ewman C. Slavens G. Use of multiple drugs among documented moderate infection of T. mchiura. Ova were adolescents who use anabolic steroids. N Engl / Med 1993; 328: 97...2-926. counted in stool specimens before and 10 days after 17. Middleman A, DuRant RH...:\.nabolic steroid use and associated health risk behaviours. Sport, Med 1996; 21(-1): 251-255. treatment by the formal-ether concentration method. 18. Nemechek PM. Anabolic steroid users - another potential risk group for HIV infection. .\1 Engl I Med 1991; 325, 357. Setting. Two shelters for abandoned and orphaned children 19. Van der Merwe PI, Kruger HSl. Drugs in sport: results of the past 6 years of dope testing in in Durban. South Africa. S Afr Med 11992; 820 151-153. 20. lidestad SD, Lambert MJ. Schwellnus MP. A survey to determine types and dosages of Participants. inety-six children aged between 2 and 12 anabolic androgenic steroids used by competiti\'e body builders in South Africa. SA /ollrnal of Sports Medicine 1994; 1(2): 24-2 . years. 21. 5chwellnus ~{P, Lambert MI.. TOOd ~iP,. ]uritz.P1. Androgenic anabolic steroid use in matric pupils. A survey of prevalence of use in the western Cape. 5 Afr Med / 1992; 82: 154-1- . Outcome measures. The number of children who showed 22 Todd MP. The use of anabolic steroids by high school pupils in Cape Town: a survey. reduced T. trichiura ova counts after the treatments, and Submitted in partial fulfilment of the requirements for a BSc Hons degree in the Department of Mathematical Statistics, L'niver5ity of Cape Town, 1991. reductions in ova counts, both expressed as percentages. 23. Yesalis CE. Incidence of anabolic steroid use: a discussion of methodological issues. In: Yesalis C, ed. Anabolic Steroids in Sport and ExerCise. Champalgn, Ill: Human Kinetics Statistical analysis using the Wilcoxon 2-sample test and the Publishers. 1993; -19-70. chi-square test. 24. Smart R, Blair ~. Test-retest reliability and validity information for a high .school drug use programme. Drug Alcohol Depend 1978; 3, 265-271. Results. Eighty-two children completed the trial; 42 received 25. Nilsson S. Androgenic anabolic steroid use among male adolescents in Falkenberg. Eur JGin Ph:mnDcol 1995; 48, 9-11. mebendazole and 40 albendazole. Of the mebendazole group 26. World Health Organisation. Meetmg on Research InitlQtive on Drugs and Sports 1993. Geneva: 85% showed a reduction in T. trichiura ova count, compared WHO. 7-11 lune 1993. 27. Wang MQ Yesalis CE. Fitzhugh EC, 8uckley WE. Desire for weight gam and potential risks with 75% of children who received albendazole. of adolescent males using anabolic steroids. Percept Mot Skills 1994; 78: 267-274. Mebendazole treatment was associated with a median 28. Goldberg L, Elliot DL, Clarke GN, et al. The Adolescents Training and Learning to Avoid Steroids (ATLAS) prevention programme. Background and results of a model intervention. percentage reduction in ova count of 72.2%, which Arch PediD/r Adoles< Med 1996; 1500 713-721. significantly exceeded the 44.1% reduction after albendazole Accepted 14 lan 1998. (P = 0.024). Conclusian. The mebendazole 500 mg single-close therapy was more efficacious than the albendazole 400 mg single­ dose therapy in treating T. trichiura infection in these children. S Afr Med J1998; 88: 880-883. Medical Research Council, Durban TFHG Jackson, PhD SR Epstein, MedTech (SA) E Gouws. MSc jansse1l-Cilag, PO Box 785939, Sand/on, 2146 RF Cheetham, MSc July 199 , VO!. 0.7 SAMJ , ORIGINAL ARTICLES Trichuriasis is an extensive worldwide health problem with microscope, and dilute Lugol's iodine was used as a stain. The estimates indicating that some 500 million people are infected counts were expressed as eggs per gram of stool. Ninety-six with Trichuris,' Although found in all communities, parasitic children with a moderate infection (5 - 70 ova per cover slip on diseases tend to be associated with poverty, and one estimate low power) were selected for the trial. of the prevalence of T. trichiuYa infections in school-going children in a peri-urban area of KwaZulu- latal is 47%-' TreatInent and follo-w-up Intestinal parasitic infections impact on morbidity widely. These children then received either a single 500 mg dose of Trichuriasis has been associated with protein energy mebendazole (Vermox; Janssen-Cilag) or a single 400 mg dose malnutrition,' which in turn has behavioural and cognitive of albendazole (Zental; SmithKline Beecham). The drugs were effects. In a Jamaican study by Simeon et ai' it was shown that packaged identically and administered under the supervision T. trichiura infection combined with poor nutritional status had of a clinician in a single-blind manner according to a an adverse effect on school performance. Trichuriasis has also randomisation schedule prepared by the Janssen Research possibly been linked with poor attention in school-going Foundation, Belgium. The staff supervising the children were children.' T. trichillYa infection is one of the most difficult asked to note any adverse experiences reported by them, parasitic infections to treat effectively. For example, Hall and particularly during the 24-hour period following drug aharS found that although albendazole initially appeared to administration.Ten days after treatment stool collections were inhibit ova production, it was later resumed. Results of other repeated and 1 g duplicate samples of each specimen were investigations also support the fact that trichuriasis is more processed for quantitative T. trichiura ova counts, as above. difficult to treat than other parasitic infections such as ascariasis and hookworm.·.7 Statistics Mebendazole and albendazole are both benzimidazole In order to show a 25% difference in parasite reduction carbamate drugs. Mebendazole has a broad spectrum of between the two treatment groups, with 80% power and anthelmintic activity, including trichuriasis, hookworm, significance at the 5% level, 80 children were required to ascariasis, enterobiasis, strongyloidiasis and tapeworm. The complete the study. The distribution of the ova counts, as well drug is not absorbed from the host's intestine to any significant as the percentage reduction in ova counts, deviated degree and appears to work by irreversibly blocking glucose significantly from normality and so the results were uptake in the parasite, leading to depletion of the parasite summarised in terms of medians and interquartile ranges. The glycogen, decreased formation of adenosine triphosphate and significance of the difference between groups was assessed cell death.· Albendazole has a similar spectrum of activity to using the Wilcoxon 2-sample test. The chi-square test was used mebendazole, but its mode of action differs in that it is to compare the groups with respect to the percentage of absorbed from the host's intestine.· children showing a reduction in ova burden. Mebendazole has been available as a multiple daily dose formulation on the South African market for many years. The Ethical approval advent of the single-dose regimen for mebendazole and the This study was approved by the Postgraduate (Ethics) availability of albendazole for human treatment prompted the Committee of the Faculty of Medicine, University of atal, decision to conduct this comparative trial in South Africa. Durban. METHODS RESULTS Subjects and stool specimens Patient cLaracteristics One hundred and seventy-five children between the ages of One hundred and fifty-three (88%) of the 175 children screened 2 and 12 years (mean 8 years) were screened for this study. were positive for T.