The prevalence and intensity of infection with soil-transmitted helminths tends to be low in children aged less than 24 months. Nevertheless, there is growing evidence that infection detrimentally affects their growth and development. This age group of children has so far been excluded from regular deworming campaigns.

Recently, a WHO informal consultation was convened to reassess the use of the benzimidazole drugs - albendazole and mebendazole - for use in this age group. Levamisole and pyrantel, the other two drugs on the WHO Model List of Essential Medicines to treat soil-transmitted helminths, were not discussed because their original manufacturers did not indicate that they should be withheld from children less than 24 months of age.

A review of available data on health benefits of treating soil-transmitted helminth infections in these young children concluded that treatment reduced the likelihood of growth stunting and favourably influenced nutritional and cognitive outcomes. The conference also reviewed human and animal toxicological data and concluded that in children as young as 12 months there are no reasons for exclusion from treatment with albendazole or mebendazole according to existing literature and company drug information (1). Hence, a recommendation was made that children from one year old onwards should be included in systematic deworming programmes. The meeting agreed on a reduced initial dose of 200 mg of albendazole, and the usual 100 mg twice a day for three days or the single dose of 500 mg of mebendazole, for children aged 12-24 months.

For children less than 12 months of age, because they are less likely to be infected and there is a marked paucity of safety data, no new recommendations were made for this age group (2).

References

1. Montresor, A., Awasthi, S., Crompton, D.W.T. Use of benzimidazoles in children younger than 24 months for the treatment of soil-transmitted helminthiasis. Special Issue: Action starts now to control disease due to schistosomiasis and soil-transmitted helminthiasis. Acta Tropica, (In press.)

2. World Health Organization. Report of the WHO Informal Consultation on the use of praziquantel during pregnancy/lactation and albendazole/mebendazole in children under 24 months. Geneva, 8-9 April 2002. Geneva, WHO Document (in press).