Mebendazole treatment of dracunculiasis

MULLER,(1979) claimed that no alteration of the adult Dracunculus medinensis or its larvae was seen after benzimidazole treatment. Further trials established that several benzimidazole drugs reduced the inflammation and lessened the duration of disabilities. Mebendazole was used by KALE (1975) in a dose of 400 mg daily for 5 d, and by PAUL et al. (1983) in a daily dose of 1000 mg for 10 d. Both studies showed that mebendazole promoted rapid healing of worm emergence ulcers, induced earlier expulsion or easier manual extraction of worm, and prevented clinical relapse, However, the authors agreed that mebendazole had only moderate efficacy but was fairly well tolerated. The proposal to schedule mebendazole in primary health drug lists for villages in areas of Bénin with endemic dracunculiasis prompted this field trial. The trial was carried out in 4 villages of the central part of Bénin, consisting of about 200 people each. The villages were surveyed for 4 years to obtain epidemiological data; the average incidence of dracunculiasis was 31%, 35%, 20% and 12% respectively. During the first year no treatment was given to villagers except for management of wounds. In the second year and &er, antibiotics and anti-inflammatory drugs were adminstered when necessary. The trial took place insthe third and fourth years. Patients were allocated to 2 groups. The &st group (iG.7 patients) received 400 mg mebendazole daily for 5 d every week during the entire duration of their disease; the dosage was not adjusted for age or weight. The second group (613 patients) received normal supporuve treatment without mebendazole. Weekly follow-up was conducted during the entire transmission season (September-May). At each examination, everyone in the trial was asked to complete a questionnaire recording duration of disease and disability, number of worms, location of emergence, and number of non-emerged worms. The diagnosis of a non-emerged worm was made on the presence of non-traumatic oedema or worm migration trails under the skin. Neither disease duration nor disability duration were significantly different between the 2 groups (P>0*05; Table 1). Non-emerged worms were much