Ivermectin and albendazole coadministration: opportunities for strongyloidiasis control

Abstract

In 2020, WHO recognised the importance of strongyloidiasis alongside soil-transmitted helminths (STH) in their2021–30 roadmap, which aspires to target Strongyloides stercoralis with preventive chemotherapy by use of ivermectin.Combination treatment with both albendazole, the primary drug used to treat STH, and ivermectin, would improvethe efficiency of mass drug administration targeting both STH and S stercoralis. In this Personal View, we discuss thechallenges and opportunities towards the development of an efficient control programme for strongyloidiasis,particularly if it is to run concurrently with STH control. We argue the need to define the prevalence threshold toimplement preventive chemotherapy for S stercoralis, the target populations and optimal dosing schedules, anddiscuss the added benefits of a fixed-dose coformulation of ivermectin and albendazole. Implementation of anefficient control programme will require improvements to current diagnostics, and validation of new diagnostics, totarget and monitor S stercoralis infections, and consideration of the challenges of multispecies diagnostics forS stercoralis and STH control. Finally, the evolution of ivermectin resistance represents a credible risk to controlS stercoralis; we argue that genome-wide approaches, together with improved genome resources, are needed tocharacterise and prevent the emergence of resistance. Overcoming these challenges will help to reduce strongyloidiasisburden and enhance the feasibility of controlling it worldwide.