Background and Aim:
Drug resistance in intestinal parasites poses an increasing threat to the control and treatment of parasitic diseases, especially in the children as a vulnerable population. This phenomenon challenges the success of disease control programs and highlights the need for new therapeutic strategies. The purpose of this systematic review was to assess the current state of treatment resistance in common intestinal parasites that affect Iranian children and to suggest innovative ways to deal with this problem. Methods: A systematic study was conducted in PubMed, Scopus, Web of Science, SID, and
Iran Medex databases using keywords "drug resistance," "intestinal parasites,” “children,” “Iran,” “mebendazole," "albendazole," "pyrantel pamoate," "metronidazole," "Giardia," "Ascaris," "oxyurid," "Enterobius," and "hookworm. Articles published from ۲۰۰۰ to ۲۰۲۵ that studied drug resistance or treatment efficacy in common intestinal parasites in Iranian children were included. After quality evaluation, ۴۸ articles were chosen for the present study out of the ۲۱۵ retrieved publications. The information on parasite species, medications taken, drug resistance rates reported were gathered and analyzed. Results: Studies showed that common intestinal parasites in Iranian children are Giardia lamblia, Ascaris lumbricoides, Enterobius vermicularis, and hookworms including Ancylostoma duodenale and Necator americanus. Mebendazole and Albendazole had reduced efficacy in treating Ascaris and hookworms, and Metronidazole for Giardia. Some studies have reported treatment failure rates with mebendazole for Ascaris up to ۳۰% and metronidazole resistance in Giardia up to ۲۰%. Major challenges include the lack of a comprehensive drug resistance surveillance system, and the overdosing of medications. Novel therapeutic strategies, including combination therapies and the development of new drugs, were discussed. Conclusion: There is a significant concern about drug resistance in Iranian
Children intestinal parasites. Continuous surveillance of resistance, and implementation of strict adherence to treatment protocols, and enhancement of public awareness are crucial to solve this problem. Drugs like Ivermectin (particularly when used in conjunction with albendazole for certain nematodes), Nitazoxanide, and Tinidazole have become viable substitutes for Giardia in cases where the nematode is resistant to benzimidazoles (albendazole and mebendazole) and nitroimidazoles (metronidazole).
