Abstract / Summary
Background: Preventive chemotherapy via single-dose benzimidazoles remains the core strategy for soil-transmitted helminth (STH) control. However, single-dose regimens often yield sub-optimal clearance against species such as Trichuris trichiura and hookworm. This systematic review and meta-analysis evaluated the comparative efficacy of repeated-dose versus standard single-dose albendazole or mebendazole regimens in paediatric populations. Methods: Registered prospectively on PROSPERO (CRD420261491616), a comprehensive search of PubMed, Embase, Cochrane Library, and Google Scholar identified clinical trials comparing repeated-dose against single-dose albendazole or mebendazole in paediatric STH infections. Primary outcomes were cure rate (CR) and egg reduction rate (ERR). Random-effects models synthesized pooled odds ratios (OR) and mean differences (MD). Risk of bias was assessed using the Cochrane RoB 2 tool. Results: Five randomized clinical trials (N = 1,718 participants) met the inclusion criteria. Overall, repeated dosing demonstrated significant superiority in cure rate (pooled OR = 4.47, 95% CI: 1.58-12.67; I{superscript 2} = 92%) and egg reduction rate (pooled MD = 0.17, 95% CI: 0.01-0.32; I{superscript 2} = 87%). Discussion: Repeated-dose benzimidazole regimens offer superior overall therapeutic efficacy compared to standard single-dose administration in children. However, this therapeutic advantage is drug-specific: multi-dose albendazole consistently enhances parasite clearance across trial settings, whereas multi-dose mebendazole exhibits variable performance and lacks conclusive superiority over single dosing. Conclusion: Transitioning to targeted, multi-dose albendazole protocols--rather than mebendazole--may serve as an effective public health intervention to eliminate residual parasite reservoirs in high-transmission endemic regions.