Investigation of Salicylanilides as Botulinum Toxin Antagonists

Botulinum neurotoxin serotype A (BoNT/A) is recognized by the Centers for Disease Control and Prevention (CDC) as the most potent toxin and as a Tier 1 biowarfare agent. The severity and longevity of botulism stemming from BoNT/A is of significant therapeutic concern, and early administration of antitoxin-antibody therapy is the only approved pharmaceutical treatment for botulism. Small molecule therapeutic strategies have targeted both the heavy chain (HC) and the light chain (LC) catalytic active site and α-/β-exosites. The LC translocation mechanism has also been studied, but an effective, nontoxic inhibitor remains underexplored. In this work, we screened a library of salicylanilides as potential translocation inhibitors. Potential leads following a primary screen were further scrutinized to identify sal30, which has a cellular minimal concentration of a drug that is required for 50% inhibition (IC50) value of 141 nM. The inquiry of salicylanilide sal30's mechanism of action was explored through a self-quenched fluorogenic substrate conjugated to bovine serum albumin (DQ-BSA) fluorescence, confocal microscopy, and vacuolar H+-ATPase (V-ATPase) inhibition assays. The summation of these findings imply that endolysosomal proton translocation through the protonophore mechanism of sal30 causes endosome pH to increase, which in turn prevents LC translocation into cytosol, a process that requires an acidic pH. Thus, the inhibition of BoNT/A activity by salicylanilides likely occurs through disruption of pH-dependent endosomal LC translocation. We further probed BoNT inhibition by sal30 using additivity analysis studies with bafilomycin A1, a known BoNT/A LC translocation inhibitor, which indicated the absence of synergy between the two ionophores.

Identification of Potent and Safe Antiviral Therapeutic Candidates Against SARS-CoV-2

COVID-19 pandemic has infected millions of people with mortality exceeding >1 million. There is an urgent need to find therapeutic agents that can help clear the virus to prevent severe disease and death. Identifying effective and safer drugs can provide more options to treat COVID-19 infections either alone or in combination. Here, we performed a high throughput screening of approximately 1,700 US FDA-approved compounds to identify novel therapeutic agents that can effectively inhibit replication of coronaviruses including SARS-CoV-2. Our two-step screen first used a human coronavirus strain OC43 to identify compounds with anti-coronaviral activities. The effective compounds were then screened for their effectiveness in inhibiting SARS-CoV-2. These screens have identified 20 anti-SARS-CoV-2 drugs including previously reported compounds such as hydroxychloroquine, amlodipine besylate, arbidol hydrochloride, tilorone 2HCl, dronedarone hydrochloride, mefloquine, and thioridazine hydrochloride. Five of the newly identified drugs had a safety index (cytotoxic/effective concentration) of >600, indicating a wide therapeutic window compared to hydroxychloroquine which had a safety index of 22 in similar experiments. Mechanistically, five of the effective compounds (fendiline HCl, monensin sodium salt, vortioxetine, sertraline HCl, and salifungin) were found to block SARS-CoV-2 S protein-mediated cell fusion. These FDA-approved compounds can provide much needed therapeutic options that we urgently need during the midst of the pandemic.

Repositioning of Anthelmintic Drugs for the Treatment of Cancers of the Digestive System

Tumors of the digestive system, when combined together, account for more new cases and deaths per year than tumors arising in any other system of the body and their incidence continues to increase. Despite major efforts aimed at discovering and validating novel and effective drugs against these malignancies, the process of developing such drugs remains lengthy and costly, with high attrition rates. Drug repositioning (also known as drug repurposing), that is, the process of finding new uses for approved drugs, has been gaining popularity in oncological drug development as it provides the opportunity to expedite promising anti-cancer agents into clinical trials. Among the drugs considered for repurposing in oncology, compounds belonging to some classes of anthelmintics—a group of agents acting against infections caused by parasitic worms (helminths) that colonize the mammalian intestine—have shown pronounced anti-tumor activities and attracted particular attention due to their ability to target key oncogenic signal transduction pathways. In this review, we summarize and discuss the available experimental and clinical evidence about the use of anthelmintic drugs for the treatment of cancers of the digestive system.

Efficacy of herbal extracts and closantel against fenbendazole-resistant Haemonchus contortus

This study assessed the efficacy of closantel vis-à-vis herbal extracts with known anti-parasitic properties, against fenbendazole-resistant nematodes in goats maintained under a semi-intensive system of management at the University goat farm, Jabalpur. Fifty goats were randomly assigned to five groups, each comprising 10 animals, irrespective of their breed, age and sex. Each animal in Group I, II and III was orally administered with aqueous leaf extracts of neem (Azadirachta indica) at 1 g/kg body weight, sitaphal (Annona squamosa) at 1.5 g/kg body weight and tobacco (Nicotiana tabacum) at 1 g/kg body weight, respectively, whereas Group IV was an untreated control group. Each animal in Group V was orally treated with closantel at 10 mg/kg body weight. During the course of the study, all animals were maintained under an identical semi-intensive system of management. Compared to the untreated control group (Group IV), there was no conspicuous reduction in post-treatment (day 10) faecal egg counts (FEC) in animals administered with the herbal extracts (Groups I, II and III), which is suggestive of poor anti-parasitic activity. However, using the faecal egg count reduction test (FECRT), the overall efficacy of closantel was recorded as 95.64%. This supports the rotational use of closantel as a preferred choice over the benzimidazole group of anthelmintics and/or herbal extracts to meet the acute challenge of in situ development of drug-resistant gastrointestinal nematodes, especially Haemonchus contortus.

Anthelmintic resistance in gastrointestinal nematodes of beef cattle in the state of Rio Grande do Sul, Brazil

Gastrointestinal nematodes resistant to anthelmintics have been reported in several regions of Brazil, and they may be associated with economic losses for the cattle industry. This study aimed to evaluate the resistance status of gastrointestinal nematodes from naturally infected beef cattle to several commercially available anthelmintics, as well as to test the efficacy of combinations of anthelmintics against multi-resistant gastrointestinal nematodes. Ten farms located in Rio Grande do Sul state were selected by: farmers' consent; extensive raising system; availability of calves aged from 7 to 9 months naturally infected by gastrointestinal nematodes; absence of anthelmintic treatment for 60 days before the study; and presence of 70-100 calves or more of both genders with ≥ 200 eggs per gram of feces (EPG) (sensitivity of 50 EPG). These calves were distributed into 10 groups (of 7-10 animals) per farm and treated with ivermectin, doramectin, eprinomectin, fenbendazole, closantel, nitroxynil, disophenol, levamisole, albendazole, or moxidectin. Feces were collected 2 days before treatment and 14 days after treatment. Additional groups of 7-10 calves were used to test six different two-drug combinations at four of the studied farms. In general terms, fenbendazole was the most effective drug, followed by levamisole, disophenol, and moxidectin. However, parasite resistance to multiple drugs was found in all herds, especially in the genera Cooperia spp., Trichostrongylus spp., and Haemonchus spp.. Some of the two-drug combinations were effective against nematode populations identified as resistant to the same compounds when used as single drugs. The most effective combinations were moxidectin + levamisole, doramectin + fenbendazole, and levamisole + closantel. In this study, parasites resistant to the main commercially available anthelmintics were found in all herds, and some combinations of two active components belonging to different chemical groups were effective against multi-drug resistant gastrointestinal nematodes.

Integrating fasciolosis control in the dry cow management: the effect of closantel treatment on milk production

The liver fluke Fasciola hepatica is a parasite of ruminants with a worldwide distribution and an apparent increasing incidence in EU member states. Effective control in dairy cattle is hampered by the lack of flukicides with a zero-withdrawal time for milk, leaving the dry period as the only time that preventive treatment can be applied. Here, we present the results of a blinded, randomized and placebo-controlled trial on 11 dairy herds (402 animals) exposed to F. hepatica to 1) assess the effect of closantel treatment at dry-off (or 80-42 days before calving in first-calving heifers) on milk production parameters and 2) evaluate if a number of easy-to-use animal parameters is related to the milk production response after treatment. Closantel treatment resulted in a noticeable decrease of anti-F. hepatica antibody levels from 3-6 months after treatment onwards, a higher peak production (1.06 kg) and a slightly higher persistence (9%) of the lactation, resulting in a 305-day milk production increase of 303 kg. No effects of anthelmintic treatment were found on the average protein and fat content of the milk. Milk production responses after treatment were poor in meagre animals and clinically relevant higher milk production responses were observed in first-lactation animals and in cows with a high (0.3-0.5 optical density ratio (ODR)), but not a very high (≥ 0.5 ODR) F. hepatica ELISA result on a milk sample from the previous lactation. We conclude that in dairy herds exposed to F. hepatica, flukicide treatment at dry-off is a useful strategy to reduce levels of exposure and increase milk production in the subsequent lactation. Moreover, the results suggest that treatment approaches that only target selected animals within a herd can be developed based on easy-to-use parameters.

The effect of a parenteral ivermectin/closantel injection on the growth and reproductive development of early immature Fasciola hepatica in cattle

Sixteen calves approximately 6 months old were each infected with 500 metacercariae of Fasciola hepatica. Thirty-two days later they were weighed and divided into two groups, and on day 35 all calves in one of the groups were injected subcutaneously with an ivermectin/closantel combination. Both groups were sacrificed between days 70 and 72 to enable counting and examination of the flukes recovered from the bile ducts. Eggs released by the flukes were collected for incubation, hatching and estimation of egg viability. Flukes were counted, flat-fixed in 70% ethanol, stained with catechol and carmine and measured. The reproductive organs, namely testis, vitelline glands, ovary and uterus, were examined and scored on a 0-3 scale according to their state of development. This was visually assessed on the basis of size, distribution and staining density of their constituent tissues and the abundance of eggs in the uterus. A representative sample of flukes from each animal was fixed in formalin for histological sectioning to enable more detailed examination of the reproductive structures. Treatment of the immature flukes reduced the population in cattle by 42.6% as compared with the controls and as a result of the stunting effect due to the presence of closantel during early development the size of treated flukes was reduced by 43.9%. A bimodal pattern of size and reproductive score was also observed in flukes from treated cattle, suggesting that the stunting effect on individual flukes differed depending on whether or not they had gained access to the bile ducts or were still migrating in the hepatic parenchymal tissue at the time of drug exposure with the effect being greater once the fluke had gained access to the bile ducts. The mean reproductive score for untreated flukes was 8.76 and for treated flukes 5.64, a 35.6% reduction. This difference was highly significant (p<0.001). Egg shedding from treated flukes was significantly less than that from controls (p<0.05), but there were no differences in hatchability, suggesting that whilst drug treatment reduced the energy supply available for gametogenesis/oogenesis, it did not induce functional defects in the gonads or accessory reproductive organs. Histological examination confirmed that there was a reduction in development of testes, ovaries and vitellaria in treated flukes, with a consequent reduction in egg production. In the treated flukes, early spermatogonia and oogonia were the predominant cell types in the testes and ovary, whilst undifferentiated stem cells were abundant in the vitelline follicles. In untreated flukes, cells representing more advanced stages in gametogenesis and vitellogenesis predominated in the respective organs. It is likely that this inhibition of gametogenesis and vitellogenesis was caused by the effects of closantel treatment on intermediary metabolism in the flukes. Clearly these effects were evident even at a relatively early stage of fluke growth, and because of the impact on egg output may have epidemiological importance in addition to the reduction in fluke numbers.

Field trial on the efficacy of an experimental fasciolicide compared with some commercial compounds in naturally infected cattle

The efficacy of 5-chloro-2-methylthio-6-(1-napthyloxy)-1H-benzimidazole was evaluated with three commercial fasciolicides in terms of the percentage of egg reduction in cattle. Fifty Swiss cows were selected for inclusion in the trial based on finding eggs of Fasciola hepatica in their feces. On day 0, they were blocked in five groups (G) of ten animals each according to fecal egg counts. G1 received compound alpha at 12 mg/kg p.o.; G2 triclabendazole at 12 mg/kg p.o.; G3.closantel at 3.5 mg/kg s.c.; G4 clorsulon at 2.0 mg/kg s.c. G5 animals served as untreated controls. Fecal analysis was performed on days 0, 7, 14, 21, 28, 60 and 90. Efficacy was measured on days 14 and 21. In addition, the extension and intensity effects were determined on day 60. The percentage efficacy for groups 1-4 was 98.1, 98.7, 98.2 and 97.9 on day 14 and 98.5, 97.9, 97.7 and 97.9 on day 21, respectively. No statistical differences were observed between treated groups.

The relationship between nasal myiasis and the prevalence of enzootic nasal tumours and the effects of treatment of Oestrus ovis and milk production in dairy ewes of Roquefort cheese area

Infection by Oestrus ovis is common in Lacaune dairy ewes of Roquefort cheese area (Aveyron, France). It is believed by local breeders that there is a close relationship between nasal myiasis and the incidence of enzootic nasal tumour. In order to check these anecdotal reports, a serological survey was done on 658 breeding ewes before turn-out and 897 breeding and primiparous (hoggets) ewes at the end of the grazing season. By the time of sampling, it was clear whether the sheep were infected at the end of the winter or had been re-infected over summer. In April and September, 40.7 and 26.3%, respectively, were free of O. ovis infection, indicating that the autumn treatment was not completely effective and that O. ovis adult flies were circulating during the summer in many flocks. There were no differences in the incidence of adenocarcinoma between the groups indicating that there is no relationship between O. ovis infection and the presence of the cancer. Differences in milk production between the three groups were not statistically significant (Anova test P>0.05). In flocks where 1-5% of the ewes were infected or in non-infected flocks, ewes produced 3.6 and 8.56%, respectively, more milk than ewes from flocks where more than 5% of animals were infected. For primiparous ewes, the differences were of 8.5 and 12.24%.

Strategic use of moxidectin or closantel in combination with levamisole in the control of nematodes of sheep in the highlands of central Kenya

The strategic use of moxidectin or closantel in combination with levamisole (LEV) to control gastrointestinal nematodes of sheep in the highlands of central Kenya was examined. Thirty Corriedale female lambs aged between 6 and 8 months were assigned to three treatment groups of ten lambs each. The three groups of lambs were set stocked on separate paddocks for the entire study period of 12 months. Lambs in Group 1 were dewormed strategically with moxidectin at 0.2 mg/kg body weight and those in Group 2 with closantel at 10 mg/kg body weight together with LEV at 7.5 mg/kg body weight. These strategic treatments were given 3 weeks after the onset of both the short and long rains and at the end of the long rainy season. The third group of lambs remained untreated (control group). Nematode infections in the treated groups of lambs and larval infectivity for the pastures on which the lambs were grazing were well controlled compared with the untreated control group. This resulted in higher weight gains and packed cell volume (PCV) in the treated lambs compared with the untreated lambs. These parameters were comparable between the lambs treated with moxidectin and those treated with closantel plus LEV. The estimated monitory benefit per animal from the control of gastrointestinal nematodes using moxidectin or closantel in combination with LEV when compared with animals in the control group were US dollars 26 and 25, respectively. It was concluded that worm control strategies for sheep in the study area, which are based on anthelmintic treatments during the rainy seasons, are effective. Due to the extended period during which pastures remain infective in the high rainfall central highlands of Kenya, anthelmintics with sustained action such as moxidectin or closantel may be most effective. On farms where resistance to the commonly used benzimidazoles or LEV groups of anthelmintics has developed, moxidectin or closantel may be used in helminth control programs for sheep.

[Photocontact dermatitis due to ketoprofen and photosensitization to tetrachlorosalicylanide and to Fenticlor(R)]

BACKGROUND

Photoallergy to ketoprofen and cross reactivity of ketoprofen with diphenylketones are well known; here are some cases of photoreaction to ketoprofen and unusual substances.

PATIENTS AND METHODS

Eleven photoallergic to ketoprofen patients were photo patch tested with Ketum(R), ketoprofen, oxybenzone, tiaprofenic acid, fenofibrate, and also chlorphenesin, sunscreen series, and photobiologists series (without lichen mix and benzocaine). We performed tests at day 0, we irradiated them with UVA at day 2, and control series remained closed. We performed readings at day 3 and 4 according to ICDRG's recommendations.

RESULTS

Nine tested patients had positive reactions to the irradiated tests with no expected allergens: fenticlor (9 cases), halogenated salicylanilides (4 cases), dibenzoylmethane (3 cases) and cinnamate (1 case).

DISCUSSION

The mechanism of these unusual photosensitizations is discussed. These cases show that it is important to test sunscreen series and photobiologists series in patients photoallergic to ketoprofen.

Strategic control of gastrointestinal nematodes of sheep in the highlands of central Kenya

The effectiveness of anthelmintic treatments given 3 weeks after the onset of rains to control gastrointestinal nematodes in sheep in the highlands of central Kenya was investigated. The study was carried out on a farm situated approximately 85 km north west of Nairobi in Nyandarua District of central Kenya. In May 1999, 35 Corriedale ram lambs aged between 8 and 10 months were eartagged, weighed and given albendazole at 3.8 mg/kg body mass. The animals were then allocated to three treatment groups. Three weeks after onset of both the short and long rains' season in November 1999 and April 2000 respectively, lambs in groups 1 and 2 were dewormed. Lambs in group 1 were given closantel at 10 mg/kg body mass in November and closantel plus albendazole at 3.8 mg/kg body mass in April. Lambs in group 2 were given albendazole at 3.8 mg/kg body mass on both occasions, while lambs in group 3 were maintained as the untreated controls. Nematode eggs per gram of faeces (epg) for lambs in the control group were significantly higher (P < 0.05) than in the treated groups beginning from November, when the strategic treatments started. The levels of epg did not differ significantly between the two treated groups. Body mass for the treated groups was significantly higher (P< 0.05) than for the control group from January 2000 until the experiment was terminated. The rainfall received in the study area in 2000 during the long rain season was inadequate and only occurred for a short period. The amount of herbage on pastures was therefore not adequate and all the study animals started losing mass from June 2000 until the experiment was terminated. The cumulative mass gain and amount of wool produced by the treated lambs during the study period did not differ significantly. There was therefore no difference in using either of the two drugs. It is concluded that, strategic anthelmintic treatments of sheep at the start of the wet season in the highlands of central Kenya is effective in controlling gastrointestinal nematodes. To prevent high levels of re-infection during the season of the long rains (April to June), it is recommended that, during this season, a second treatment be given 5-6 weeks after the first one or at the start of the dry season.

Anthelmintic resistance on an organized sheep farm in India

Monitoring anthelmintic resistance in strongyle nematodes by the faecal egg count reduction test and a commercial larval development assay on an organized sheep farm in the semi-arid area of Rajasthan revealed the emergence of resistance to benzimidazoles and rafoxanide and a potential risk of the development of levamisole/tetramisole resistance. A benzimidazole/levamisole combination, avermectins and closantel were each found to be efficacious.

[The synthesis and study of the trichinellacidal activity of bromine and chlorine derivatives of 8-quinolyloxysalicylanilides]

Some new bromine (chlorine) derivatives of 8-quinolyloxysalicylanilides were synthesized and tested for trichinellacidal activity. Among them there was the substance N-[3-bromophenyl-4-(5-chloroquinolinoxy)]-3,5-dibromosalicylami de which exhibited its high trichinellocidal activity (in albino mice infected with decapsulated Trichinella spiralis) that was close to that of mebendazole.

Fasciolicides: efficacy, actions, resistance and its management

The modes of action of fasciolicides are described. Closantel and other salicylanilides interfere with energy metabolism by uncoupling oxidative phosphorylation in the fluke. Other fasciolicides are believed to have a metabolic action-halogenated phenols (via uncoupling) and clorsulon (via inhibition of glycolysis)-but direct evidence is lacking. Benzimidazoles (in particular, triclabendazole) bind to fluke tubulin and disrupt microtubule-based processes. Diamphenethide inhibits protein synthesis in the fluke. Other potential drug actions may contribute to overall drug efficacy. In particular, a number of fasciolicides-salicylanilides, phenols, diamphenethide-induce a rapid paralysis of the fluke, so their action may have a neuromuscular basis, although the actions remain ill-defined. Resistance to salicylanilides and triclabendazole has been detected in the field, although drug resistance does not appear to be a major problem yet. Strategies to minimize the development of resistance include the use of synergistic drug combinations, together with the design of integrated management programmes and the search for alternatives to drugs, in particular, vaccines.

Comparative anthelmintic activity of strategic sustained low-level administration of albendazole in feed pellets compared to single doses of closantel and tetramisole against natural ovine parasitic gastroenteritis

The strategic use of single therapeutic doses of closantel, tetramisole or sustained low-level administration of albendazole in feed pellets in controlling naturally acquired parasitic gastroenteritis in sheep was investigated on a farm in semi-arid Rajasthan, India. A total of 303 5- to 6-month-old sheep were divided into three groups. Two groups were dosed with single therapeutic doses of closantel and tetramisole and the third group was given a low-level medication with albendazole through feed pellets for 30 days. Faecal egg counts revealed significantly lower counts (p<0.001) in the group treated with closantel compared to the other two groups. The faecal egg counts in the group receiving sustained low-level albendazole rose after withdrawal of the medication but remained significantly lower than those in the group treated with tetramisole up to 7 weeks after treatment (p<0.05). On the other hand, in the group treated with tetramisole, the mean faecal egg count rose from 3 weeks after treatment and remained continuously higher than those in any other group up to 12 weeks after treatment. The closantel-treated group gained more body weight but the first six-monthly greasy fleece yield was greater in the group treated with medicated pellets. During the first 3 months of the experiment, three animals in the group treated with tetramisole died of parasitic gastroenteritis. Following sustained low-level administration of albendazole in feed pellets, the plasma disposition curve of both the sulphoxide and sulphone metabolites reached its plateau level by day 5 and remained almost constant thereafter. The comparative cost-effectiveness of the three treatment regimes during the first 3 months of treatment was best for the group treated with closantel followed by the group treated with medicated feed pellets.

Anthelmintic resistance in sheep and goat farms on Peninsular Malaysia

The faecal egg count reduction test (FECRT) was conducted on 39 sheep farms and 9 goat farms located in Peninsular Malaysia. The anthelmintic groups used in these tests were the benzimidazoles, levamisole, the benzimidazole/levamisole combination, macrocyclic lactones and closantel. Results indicated that the prevalence of resistance to the benzimidazole group was high, with approximately 50% of the sheep farms and 75% of the goat farms having resistant nematode parasite populations present. Resistance to levamisole, closantel and ivermectin was also detected. Differentiation of the infective larvae derived from faecal cultures indicated that by far the most predominant parasite species was Haemonchus contortus.

Efficacy of closantel plus albendazole liquid suspension against natural infection of gastrointestinal parasites in camels

Oral administration of closantel in a dose of 10 mg/kg plus albendazole in a dose of 5 mg/kg liquid suspension was studied in 75 camels naturally infected with various types of gastrointestinal parasites. The camels involved were 15 pregnant she-camels, 20 non-pregnant she-camels and 40 male camels of various ages. Each camel received a single oral dose of closantel (10 mg/kg) plus albendazole (5 mg/kg) orally. Two weeks later, 20 camels of this group were re-dosed again with the same dose of the anthelmintic. Fecal samples were collected per rectum from all camels at the time of treatment and again 14 and 42 days post treatment. Fecal egg counts and generic determination of third stage larvae was performed. Results indicated that six different species of gastrointestinal tract parasites were identified in camels. Single treatment of closantel plus albendazole mixture reduced egg counts in camels by 100%, 100%, 98% and 77% for Haemonchus longistipes, Ascaris spp., Monezia expansa and Fasciola hepatica, respectively. However, administration of the drug twice on the base of 2 weeks apart significantly raised the efficacy of the drug for clearance of the parasites from 92.5% to 100% in camels infected with various parasites. Camels were not adversely affected by treatment.

Multiple and multigeneric anthelmintic resistance on a sheep farm in Kenya

The anthelmintic efficacy of benzimidazoles (albendazole, fenbendazole and oxfendazole), levamisole, oral ivermectin and closantel was evaluated on a farm in Kenya using faecal egg count reduction test, larval cultures and a controlled slaughter trial. The results of this study indicated simultaneous resistance of Haemonchus contortus against benzimidazoles, levamisole and ivermectin, and of Trichostrongylus colubriformis and Oesophagostomum spp. against levamisole on the same farm. Ivermectin resistance developed to 47% within 15 months of first use. Closantel was effective against the benzimidazoles, levamisole and ivermectin resistant H. contortus.

Efficacy of closantel, albendazole and levamisole on an ivermectin resistant strain of Haemonchus contortus in sheep

Following evidence of reduced efficacy of oral ivermectin in a field population of Haemonchus contortus on a sheep farm in Kenya, this strain of the parasite was submitted to a controlled anthelmintic test. One hundred and twenty worm-free lambs were randomly split into two groups of 60. Each lamb in the first group was infected with 5000 third stage larvae (L3) of the suspected resistant strain the remaining 60 lambs were each infected with 5000 (L3) of a H. contortus strain of known susceptibility to the major groups of anthelmintic compounds used in sheep. On day 28 post-infection, each group was subdivided according to egg counts and at random into six sub-groups of ten lambs, each of which was treated with closantel at 5.0 mg kg-1, albendazole at 5.0 mg kg-1, levamisole at 7.5 mg kg-1, oral ivermectin at 0.2 mg kg-1 or injectable (Inj.) ivermectin at 0.2 mg kg-1, or was left as an untreated control. At slaughter, 10 days later, all the anthelmintics had resulted in reduced worm burdens in animals infected with the susceptible strain (albendazole 99.0%, levamisole 99.5%, closantel, Inj. and oral ivermectin 100%). By contrast, in the lambs infected with the suspected resistant strain, closantel was 100% effective, but inj. ivermectin, oral ivermectin, albendazole and levamisole reduced worm counts by 47.6%, 24.2%, 38.5% and 41.4%, respectively. Anthelmintic resistance to the other chemical groups had been confirmed previously on this farm and although benzimidazoles and levamisole had not been used for the last 4 years, this strain was still highly resistant to albendazole and levamisole; closantel remained as the only drug evaluated which was still effective against this population of H. contortus.

The strategic use of closantel and albendazole in controlling naturally acquired gastrointestinal nematodes of sheep in the Kenya highlands

The strategic use of closantel, a narrow-spectrum salicylanilide anthelmintic against bloodsucking helminths, and of albendazole, a broad-spectrum benzimidazole anthelmintic, in the control of gastrointestinal nematodes of sheep was investigated on a farm in Nyandarua District in the highlands of Kenya. Thirty Corriedale female lambs aged between 9 and 12 months were assigned to three treatment groups of 10 lambs each. The three groups were set stocked on separate paddocks for 12 months. Lambs in group 1 (strategic treatment group) were treated with closantel and albendazole at the beginning and towards the end of the long rains (April and June, respectively) and towards the end of the short rains. (December). During the intervening dry season, the lambs were treated with albendazole. Lambs in group 2 (suppressive treatment group) were kept 'worm free' by regular deworming with albendazole at 3-weekly intervals for 12 months. The third group of lambs remained untreated (control group). Gastrointestinal nematode infections and pasture infectivity were well controlled in the case of the strategic treatment group. This resulted in higher weight gains, wool production, packed cell volume, and serum albumin and protein concentrations compared with the untreated control lambs. These parameters were comparable between the strategic treatment and the suppressive treatment groups of lambs. It was concluded that worm control strategies based on the epidemiology of the parasites and the sustained anthelmintic action of closantel in combination with broad-spectrum anthelmintics can provide effective control of gastrointestinal nematodes of sheep in the study area.

Multiple anthelmintic resistance in Haemonchus contortus on a sheep farm in Kenya

Multiple resistance to albendazole, thiophanate, levamisole and orally administered invermectin was detected in an isolate of Haemonchus contortus in sheep on a farm where benzimidazole resistance had already been identified. Following a faecal egg count reduction test, this was confirmed by both critical and controlled anthelmintic tests. Different groups of sheep infected naturally or given an experimental infection with the benzimidazole-resistant isolate were treated with the recommended doses of various anthelmintics. Compared to the control group, the percentage reductions in the faecal egg counts of sheep treated with albendazole, thiophanate, levamisole and ivermectin varied between 38.2% and 79.1% and the residual worm counts between 27.3% and 57.5%. The results indicate the presence of multiple anthelmintic resistance in this isolate of H. contortus. Sheep treated with closantel showed 100% reductions in faecal egg and worm counts, indicating that this drug was very effective against the population of H. contortus on the farm.

Comparative curative and preventive efficacies of ivermectin and closantel on Oestrus ovis (Linné 1758) in naturally infected sheep

A field trial was undertaken to assess the efficacy of each of two formulations of ivermectin and of closantel in prevention and treatment of Oestrus ovis in a naturally infected flock grazing on the foothills of the Pyrenees mountains, in south-western France. Within the flock, 875 sheep were randomly divided into four groups, and treated twice during the fly season, with an interval of 60 days between treatments. Group 1 sheep were treated with albendazole (ABZ) at a dose rate of 3.8 mg/kg to maintain control of trichostrongylid parasites without affecting O. ovis; Group 2 received closantel at a dose rate of 10 mg/kg because of its known persistent activity against O. Ovis; Groups 3 and 4 received ivermectin at a dose rate of 200 mcg/kg bodyweight by subcutaneous injection (Isc) and orally (Io), respectively. All sheep were managed as a single group throughout the study. In order to assess the prophylactic effect of each product, immediately prior to the scheduled second treatment on Day 60 (D60), five sheep from each group were chosen at random and necropsied. Similarly, to assess the therapeutic effect, another five sheep from each group were selected on D70 and necropsied for parasite counts. During the 120 days of the trial, a significant number of animals from each group were regularly individually examined to assess their clinical status with regard to O. Ovis infection. Clinical signs of infection had significantly declined in Groups 2, 3 and 4 by 10 days after treatment reaching their lowest level at D30. In the control group during this period, clinical signs increased. Ten days after the second treatment, (D70), there was also evidence of a significant response to treatment. Finally the between-treatment differences in clinical scores of the closantel and ivermectin groups were small, although scores in Group 1 sheep was suggestive of a higher challenge in the second half of the study. On the basis of the postmortem counts and arithmetic means, prophylactic efficacies for the treatments relative to ABZ treated group, were 97.7, 62.5 and 0%, for the closantel, Isc and Io groups respectively. Therapeutic efficacies for the closantel, Isc and Io were 100, 100 and 98% respectively.

How long before resistance makes it impossible to control some field strains of Haemonchus contortus in South Africa with any of the modern anthelmintics?

This paper describes an exceptional spectrum of multiple anthelmintic resistance in two strains of Haemonchus contortus in South Africa, one from Howick in KwaZulu-Natal, and the other from Badplaas, in Mpumalanga. Apparently for the first time, a helminth strain is described with resistance to compounds from all five of the modern anthelmintic groups used for nematode control in sheep; also, two strains of H. contortus show resistance to the two substituted phenols, dinitrophenol and nitroxynil. Only closantel at 5 mg kg-1 of nine compounds tested appears to have undiminished efficacy against the Howick strain, but even in the case of closantel, the residual activity and minimal effective level need to be tested before it can be concluded that its efficiency is unaffected. The exceptional resistance of the Howick strain is demonstrated by the fact that sequential daily drenching of sheep infected with the strain, with levamisole at 18 mg kg-1, oxfendazole at 20 mg kg-1, levamisole at 20 mg kg-1 and a mixture of fenbendazole at 10 mg kg-1 plus trichlorfon at 132 mg kg-1 on the fourth day, failed to clear sheep of the infection. There are strong indications that side-resistance occurs between dinitrophenol and nitroxynil, on the one hand, and the salicylanilides, on the other, and it is suggested that, before long, strains of H. contortus will be found with high levels of resistance to all the currently available anthelmintics.

[Biological effects of substances similar to salicylanilides benzanilides]

The present review paper is the first collected communication about biological activity of benzanilides. The substances of the above-mentioned structures show a number of activities (antibacterial, ref. 1-22; antituberculous, ref. 23-25; antimycotic, ref. 26-95; antiviral, ref. 96-98, antiprotozoan, ref. 97; anthelmintic, ref. 37, 99-100; insecticidal, ref. 31, 37, 101-104; herbicidal, ref. 106-130, antitumour, ref. 131-137; immunosuppressive, ref. 134, 138; hypnotic, ref. 140; anticonvulsive, ref. 141-151, anti-inflammatory, ref. 152; local-anaesthetic, ref. 155-156; antiarrhythmic, ref. 155, 158; vasodilating, ref. 159; antiulcerative, ref. 160; anti-androgenic, ref. 161; hypoglycemic ref. 162). Only very few of them have been hitherto introduced into practice. Papers investigating biological activity of benzanilides can be encountered also at present.

In vitro and in vivo studies on salifluor/PVM/MA copolymer/NaF combination as an antiplaque agent

Salifluor (5-n-octanoyl-3'-trifluoromethyl-salicylanilide), a broad spectrum antimicrobial agent, was investigated for its ability to inhibit dental plaque formation. A combination of salifluor with PVM/MA copolymer and NaF was optimized for its antiplaque effect in mouthrinse and dentifrice formulations based on a series of both laboratory and clinical studies. It was found that salifluor, a highly hydrophobic compound, could not be adequately solubilized with the conventional amount of sodium lauryl sulfate (SLS), the most commonly used anionic surfactant in oral hygiene products. However, it was possible to prepare stable mouthrinse formulations using a mixed surfactant system containing both anionic and nonionic surfactants. The most suitable mixture was found to be a combination of SLS, Pluronic and Tauranol in a proportion of 1:1:1. This combination provided adequate stability and high antimicrobial activity as determined by in vitro microbiological tests. Addition of a PVM/MA copolymer to the formulation improved the adsorption and retention of salifluor on stimulated tooth surfaces in vitro (saliva coated hydroxyapatite disks) by almost two-fold and also increased the antiplaque efficacy in both laboratory and human clinical studies. It was also found that a non fluoride dentifrice containing a combination of salifluor and PVM/MA copolymer with a dicalcium phosphate dihydrate abrasive, was highly effective in reducing smooth surface and fissure caries in rats. The results of the present studies demonstrated that salifluor is an effective antiplaque agent in mouthrinse and dentifrice when carefully formulated to maximize its delivery and bioavailability on oral surfaces. They also illustrated the difficulties encountered in exploiting the antimicrobial efficacy of highly hydrophobic, nonionic antimicrobial agents such as salifluor in commonly used oral hygiene vehicles.

Efficacy of closantel against Fasciola hepatica in Korean native goats

Closantel (Flukiver), a salicylanilide antiparasitic compound, was tested in Korean native goats infected with Fasciola hepatica. The goats were administered closantel once orally at a dose of 10 mg/kg body weight. Efficacy was monitored weekly by fecal examination of all infected animals starting the second week post-treatment and continuing for 3 weeks. Closantel elicited 80.3, 97.8 and 92.7% efficacy in goats with naturally-acquired fasciolosis at the second, third and fourth week post-treatment, respectively. It elicited a 100% efficacy in goats experimentally infected with F. hepatica metacercariae and treated at 18 weeks post-infection.

Some effects of mouthrinses containing salifluor on de novo plaque formation and developing gingivitis

Three clinical trials were carried out to evaluate the effects of mouthrinses containing 5n-octanoyl-3'-trifluormethylsalicylanilide (salifluor) on plaque and gingivitis. Each trial was performed as a double-blind, randomised and cross-over designed study (studies 1, 2 and 3). In each study, 10 young individuals with healthy gingiva abolished all means of mechanical plaque control during the course of the experimental period including 6 x 4 days (study 1), 3 x 18 days (study 2) and 3 x 14 days (study 3). They rinsed, 2 x daily, with various mouthwash preparations for 4 days (study 1), for the last 4 days of a 18 day period (study 2) or for 14 days (study 3). 6 (control, vehicle control, 0.08%, 0.12% and 0.2% salifluor and 0.12% chlorhexidine), 3 (control, 0.12% salifluor and 0.12% chlorhexidine) and 3 (control, 0.12% salifluor and 0.12% chlorhexidine) mouthwash preparations were tested in studies 1, 2 and 3, respectively. The findings of study 1 indicated that (i) mouthrinses containing salifluor were significantly more effective than control rinses and that (ii) the salifluor mouthrinses were equally effective as the 0.12% chlorhexidine mouthrinse, in retarding 4-day de novo plaque formation. The findings of study 2 indicated that (i) the mouthrinse containing 0.12% salifluor retarded de novo plaque formation to the same extent as the 0.12% chlorhexidine mouthrinse at healthy as well as at inflamed sites but that (ii) the anti-plaque effects of the salifluor and chlorhexidine mouthrinses were significantly smaller at sites with inflamed than with healthy gingiva. In study 3, it was observed that there was no significant difference between the 0.12% salifluor and 0.12% chlorhexidine mouthrinses in retarding de novo plaque formation and the development of gingivitis during a 14-day period of no mechanical plaque control. Thus, the results of the 3 clinical trials demonstrated the potential of salifluor as an effective anti-plaque and anti-inflammatory agent.

Comparative efficacies of closantel, ivermectin, oxfendazole, thiophanate and levamisole against thiabendazole resistant Haemonchus contortus in sheep

Forty-nine sheep artificially exposed to a thiabendazole (TBZ) resistant isolate of Haemonchus contortus were assigned to 7 groups of 7 animals each and used to conduct a controlled anthelmintic trial. One group of sheep served as untreated infected controls and 6 groups were treated as follows: closantel, 5.0 mg kg-1; ivermectin, 0.2 mg kg-1; oxfendazole, 5.0 mg kg-1; thiophanate, 50 mg kg-1, levamisole, 7.5 mgkg-1 and thiabendazole, 66 mg kg-1. Eggs per gram of faeces were determined on days 21, 24 and day 34 (10 days post-treatment) after infection and all animals were necropsied for residual worm counts. The calculated efficacies of the treatments against H. contortus as indicated by worm reduction were closantel (100%), ivermectin (99.3%), oxfendazole (35.2%), thiophanate (56.7%), levamisole (98.6%) and thiabendazole (24.3%). The data therefore indicate that the TBZ-resistant isolate of H. contortus used was highly resistant to the 2 benzimidazole (BZ) anthelmintics, oxfendazole and thiophanate. This is the first report in Kenya of a field strain of H. contortus resistant to thiophanate.

The effects of closantel treatment on the ultrastructure of Haemonchus contortus

H. contortus were recovered from sheep 0-14 h after intramuscular treatment with closantel. Ultrastructural examination revealed that mitochondria were more electron dense and contained swollen cristae compared with untreated controls. Following treatment, the basal channels in the intestine became prominent and there was vesicle formation in all organs examined. In contrast, closantel-resistant H. contortus appeared normal after drug treatment. It is likely that closantel affects membrane associated processes responsible for fluid and ion homeostasis as well as mitochondrial function. Untreated H. contortus were maintained in balanced salt solution for 12 h which caused lesions indicative of fluid imbalance, but at 23 h there were serious structural abnormalities.

Evidence for multiple anthelmintic resistance in sheep and goats reared under the same management in coastal Kenya

Four experiments, two with sheep and two with goats, were carried out to determine the efficacy of ivermectin, fenbendazole, levamisole, closantel and some of their combinations by faecal egg count reduction tests. In the first experiment, injectable ivermectin, oral ivermectin, fenbendazole and levamisole were tested in 6-month-old lambs, and their reduction percentages were 77%, 13%, 42% and 92%, respectively. In the second experiment, with yearling sheep, the reduction percentages were 35% for injectable ivermectin, 32% for fenbendazole, 99% for levamisole, 48% for closantel, 92% for injectable ivermectin combined with fenbendazole, 99% for injectable ivermectin combined with levamisole, and 100% for fenbendazole combined with levamisole. In the study with 18-month-old goats given the same dose rates as those recommended for sheep, the reduction percentages were 73% for injectable ivermectin, 25% for fenbendazole, and 78% for levamisole. Another group of 14-month-old goats was treated with dose rates 1.5 times those recommended for sheep and the reduction percentages were 93% for levamisole, 92% for injectable ivermectin, and 97% for a combination of levamisole and ivermectin. In all experiments with sheep and goats the gastrointestinal nematode parasites identified by larval cultures were Haemonchus contortus, Trichostrongylus spp. and Oesophagostomum spp. The gastrointestinal nematodes of both sheep and goats on this farm are resistant to ivermectin and fenbendazole, whereas levamisole is still effective in sheep, but not in goats. The results are discussed in relation to the farm as a source of breeding stock to smallholder farmers and its potential to spread anthelmintic resistance.

Multiple anthelmintic resistance in Haemonchus contortus on a sheep farm in India

Multiple resistance to benzimidazoles (fenbendazole, albendazole and mebendazole) in a strain of Haemonchus contortus in sheep was detected on a farm where fenbendazole resistance had already been identified. Following a faecal egg count reduction test, this was confirmed by both critical and controlled anthelmintic tests. Different groups of sheep infected naturally or given an experimental infection with the fenbendazole-resistant strain were treated with the recommended doses of various anthelmintics. Compared to the control group, percentage reductions in faecal egg counts of sheep treated with fenbendazole, albendazole, mebendazole, levamisole and morantel varied between 56% and 81% and worm counts between 71% and 86%. The results indicate the presence of multiple anthelmintic resistance in this strain of H. contortus on this farm. Sheep treated with ivermectin and closantel showed 100% reductions in faecal egg and worm counts, suggesting high efficacy of these drugs against the population of H. contortus on this farm.

Characterisation of an avermectin resistant strain of Australian Haemonchus contortus

A strain of Haemonchus contortus (CAVR) isolated in Australia was found to be resistant to ivermectin (IVM) with 0.4 mg kg-1 of the anthelmintic failing to significantly reduce worm burdens. Resistance to IVM was sex-influenced in the CAVR strain with adult males showing a greater sensitivity to IVM. Cross resistance to moxidectin was evident with approximately 15% of the population surviving a dose of 0.1 mg kg-1. The free-living stages of the CAVR isolate had a reduced sensitivity to avermectin (AVM) inhibition of development and motility. Similar structure-activity patterns and resistance factors were obtained for a series of related AVMs as inhibitors of larval development and L3 motility in CAVR and White River II, an IVM-resistant H. contortus isolate from South Africa. Further, both isolates were found to be 3 times more sensitive to paraherquamide than a susceptible H. contortus isolate. This suggest that the same resistance mechanism is operating in both isolates. The CAVR strain is susceptible to the benzimidazoles, levamisole and closantel.

Multiple and multigeneric anthelmintic resistance on a sheep farm in Malaysia

The anthelmintic efficacy of benzimidazoles, levamisole, closantel, ivermectin and moxidectin was evaluated on an institutional farm in Malaysia using faecal egg count reduction tests, controlled slaughter trials and an in vitro egg hatch assay. The results of this study indicated simultaneous resistance of Haemonchus contortus against benzimidazoles and ivermectin and of Trichostrongylus colubriformis against benzimidazoles and levaminsole on the same farm. Moxidectin was effective against the ivermectin resistant H. contortus.

Control of haemonchosis in Malaysian goats with closantel

The therapeutic and prophylactic effects of closantel on natural infections with Haemonchus contortus were studied in goats in Peninsular Malaysia. Closantel was highly effective against H. contortus, either at a subcutaneous (s.c.) injection of 5.0 mg kg-1 body weight (100%), or in an oral drench mixture with mebendazole at a dose of 10.0 mg kg-1 (99.2%), as indicated by faecal egg counts. H. contortus larvae were absent from faecal cultures for 5, 6 and 7 weeks following treatment with s.c. injections of closantel at doses of 2.5 mg kg-1, 5.0 mg kg-1 and 10.0 mg kg-1 respectively, and for 6 weeks after treatment with closantel at 10.0 mg kg-1, given orally. Through its sustained activity, closantel not only prevented reinfection with H. contortus but also caused a dramatic reduction in pasture contamination. The potential utility of closantel in the strategic control of haemonchosis in goats, and as an alternative treatment for benzimidazoles and levamisole resistant H. contortus strains, is discussed.

[The synthesis and study of the acute toxicity and anthelmintic activity of salicylanilides containing a quinoline residue]

Salicylanilides containing quinoline moiety were synthesized and examined for acute toxicity and antinematodal activity. All the compounds were shown to possess a low toxicity. In the trials on a nematodal model (Aspiculuris tetraptera, white mice), 2 compounds--G-1570 and G-1575--were shown to be highly effective.

Kinetics of expulsion of Haemonchus contortus from sheep and jirds after treatment with closantel

Experiments were conducted in sheep after intramuscular treatment with closantel and in jirds after oral treatment with closantel to determine when expulsion of established H. contortus commences. Expulsion starts at about 8 h in sheep and coincides with the onset of reduced motility in worms recovered from the abomasum. In jirds, expulsion starts by 2 h after treatment. Experiments also conducted in jirds showed that infective larvae are first killed by circulating closantel 3 days after infection, when blood feeding starts, and that by 8 days 80% of larvae are lost.

Efficacy of moxidectin against a strain of Haemonchus contortus resistant to ivermectin, a benzimidazole and a salicylanilide

The efficacy of moxidectin at 0.2 mg kg-1 live body mass against the multiple anthelmintic resistant White River Krtz strain of H. contortus was determined and compared to that of ivermectin, a benzimidazole, a salicylanilide and levamisole. Moxidectin and levamisole were effective against this strain of H. contortus and reduced the arithmetic mean burdens of this parasite in the sheep by 99.98% and 99.59%, respectively, while the efficacy of ivermectin, albendazole and closantel was only 29.1%, 33.75% and 78.3%, respectively.

Efficacy of closantel against fenbendazole and levamisole resistant Haemonchus contortus in small ruminants

Sheep infected with a fenbendazole resistant strain of Haemonchus contortus and goats with a levamisole resistant strain of the same parasite were used to evaluate the anthelmintic efficacy of closantel. Closantel at the rate of 10 mg/kg body weight was 100% effective against the 2 resistant strains of the parasite as indicated by faecal egg count and worm reduction. The efficacy of fenbendazole in sheep and of levamisole in goats was 56.68 and 76.90%, respectively.

Immunological detection of chemotherapeutic success in bovine fasciolosis using the specific antigen f2

An improved hemagglutination (HA) test using the purified specific f2 antigen of Fasciola hepatica has been evaluated with regard to its potential use for the prediction of chemotherapeutic success in natural bovine infections with F. hepatica. Lactating cows (n = 16) from a herd naturally infected with F. hepatica were successively treated with nitroxynil (Dovenix, Specia) and with oxyclozanide (Zanil, ICI) 1 month later. Their f2-specific antibodies were significantly lower than those of a non-treated control group (n = 15) from the second month after the first treatment, and continued to decline thereafter to negative values 5-6 months post-treatment. In a second experiment, culled and fattened cows (n = 32) of unknown fasciolosis history were treated with closantel (Janssen Pharmaceutica). Three months after treatment, f2-specific antibodies of the serologically positive animals (n = 24) were reduced nine-fold. In contrast, in the control group (n = 28), the titers of f2-specific antibodies of the serologically positive animals (n = 21) were not modified significantly. The results show that the f2-HA test is useful for the prediction of chemotherapeutic success in bovine fascioliasis.

The survival and fecundity of buffalo flies after treatment of cattle with three anthelmintics

Two anthelmintics with known insecticidal action (ivermectin and closantel) and one with no recorded effect on insects (levamisole) were tested to evaluate their effects on buffalo fly (Haematobia irritans exigua). Blood from animals given closantel or levamisole had no significant effect on mortality of buffalo flies in an in-vitro assay. In contrast, blood from animals given ivermectin showed a dose-dependent effect on the mortality of buffalo flies. At 24 h after one injection of the recommended dose of ivermectin, 98% of the flies applied to cattle in an in-vivo assay are killed. Blood from cattle injected with ivermectin killed 95% of flies 8 d after injection and still killed 15% of flies at 18 days after injection. Surviving flies laid almost no eggs and this effect on flies was significant up to 33 d after injection. The results indicate that ivermectin may be useful to control buffalo fly populations in the field.

Effectiveness of strategic anthelmintic dosing in controlling Haemonchus contortus infections in sheep in the United Kingdom

The strategic use of anthelmintics in the control of infections of Haemonchus contortus in ewes and lambs, was investigated in a series of paddock trials. The levels of infection and clinical signs associated with the presence of either benzimidazole-resistant or benzimidazole-susceptible strains of H contortus in lambs were controlled by regular drenching with levamisole or mebendazole, respectively, or by the strategic use of closantel in combination with mebendazole. In the latter case, control was achieved by dosing either the ewes in the early part of the grazing season, or the lambs from June onwards. It was concluded that worm control strategies based on closantel could provide effective control of both benzimidazole-susceptible and benzimidazole-resistant strains of H contortus on farms in the United Kingdom.

Comparative efficacy of closantel and triclabendazole against Fasciola hepatica in experimentally infected sheep

The effect of closantel (10 mg/kg orally) and triclabendazole (10 mg/kg orally) on the reappearance of a patent infection of Fasciola hepatica was studied in experimentally infected sheep. The treatments resulted in the interruption of faecal egg output for 11 weeks with triclabendazole and 13 weeks with closantel. Necropsy of untreated control animals revealed a mean burden of 360 flukes with a mean (+/- se) surface area of 171 +/- 64.3 mm2, whereas the fluke burdens in the closantel and triclabendazole-treated animals 14 weeks after treatment were 61 (83 per cent reduction) and 21 (94 per cent reduction), respectively. The surface areas of the flukes in the triclabendazole-group were comparable with the untreated controls (141 +/- 51.8 mm2), but the flukes in the closantel group were markedly smaller (43.1 +/- 26.9 mm2). It is concluded that closantel has, in epidemiological terms, a potency comparable with that of triclabendazole, despite its slightly lower efficacy against the very immature stages.