Methods to sustain drug efficacy in helminth control programmes

Assessment of the efficacy of anthelminthic treatment in public health is a broad concept, which goes beyond parasitological methods and should be clearly defined according to several indicators of morbidity. Several factors may influence the efficacy of anthelminthic drugs. The quality of drug is an issue of great importance, especially when produced locally as a generic product and used in large-scale chemotherapy-based control programmes. Other factors include the drug–patient interaction, the host–parasite relationship, the diagnostic method used, genetic variations between parasite strains and induced drug resistance. Veterinary scientists have warned that drug resistance can be selected through frequent mass treatment of sheep and goats and have developed a body of knowledge on evaluation of efficacy and detection of resistance in nematodes of veterinary importance. In soil-transmitted nematodes infections of humans, the egg reduction rate (ERR), the egg hatch assay (EHA) and novel molecular biological techniques may be used to monitor drug efficacy in helminth control programmes and to detect early occurrence of resistance. Evidence of reduced drug efficacy of some anthelminthics has been suggested by recent studies and strategies to prevent or delay the emergence of drug resistance in human soil-transmitted nematodes.