Summary of evidence and Expert Committee recommendations
In 2009, the Committee requested a review of the evidence supporting treatment
of neglected tropical diseases in children. Neglected tropical diseases are a
group of communicable diseases that affect around 1 billion people worldwide
in 149 countries where these diseases are endemic. In at least 100 of these
countries 2 or more diseases are endemic; in 30 others 6 or more are endemic.
There are few new treatments available for the patients affected. The Secretariat
commissioned the review which was prepared by Dr Rima Al-Saffer, Specialist
Registrar, Paediatrics, United Kingdom and Dr Anna Louise Ridge, Technical
Officer, Medicine Access and Rational Use, Department of Essential Medicines
and Pharmaceutical Policies, WHO.
Expert reviews were provided Dr Lenita Wannmacher and Professor
Anita Zaidi. Comments were received from the Department of Control of
Neglected Tropical Diseases (NTDs), and from Médecins Sans Frontières.
The review focused on antischistosomal, antitrematode, anti-amoebic,
antigiardiasis and antitrypanosomal medicines as these are the categories of
medicines on the EMLc. It did not include consideration of dengue, rabies,
trachoma, endemic treponematoses, leprosy, and echinococcosis.
The Committee noted that the review, while comprehensive, was
limited to English-language articles, excluding potentially-relevant articles in
Arabic, French, Portuguese, or Spanish, which may also reflect differences in
strain susceptibility in different geographical regions. The review focuses on
the following medicines: diethylcarbamazine (DEC), diloxanide, eflornithine,
ivermectin, levamisole, mebendazole, melarsoprol, metronidazole, niclosamide,
nifurtimox, oxamniquine, pentamidine, praziquantel, pyrantel, suramin sodium,
For anthelminthics, the proposal from the expert reviews was to delete
levamisole from the Model List as the evidence is limited and its efficacy in
treating helminthic infections is less than that of albendazole, mebendazole,
The NTD Department expressed the need to retain levamisole, while
noting that its use alone is indeed becoming obsolete. It is listed in the 2006
guidelines, in combination with mebendazole, as a third-line option for the large-scale
treatment of intestinal nematodiasis. The Committee noted the comments
from the NTD Department but pointed out that the evidence does not support
continuing the inclusion of levamisole and hence recommended that it be
marked for consideration of deletion at the next meeting of the Committee. The
Committee also added a note to the List that it is recommended that levamisole
only be used in combination with other anthelminthics.