Ivermectin: panacea for resource-poor communities? Satoshi Ōmura, Andy Crump  Trends in Parasitology  Volume 30, Issue 9, Pages 445-455 (September 2014) DOI: 10.1016/j.pt.2014.07.005 Copyright © 2014 Elsevier Ltd Terms and Conditions

Figure 1 Steps in unearthing Streptomyces avermectinius. (A) Soil sample. (B) Identifying structurally distinct organisms from the sample. (C) Culturing unique organism prior to screening for bioactivity. Photographs by Andy Crump. (D) Identifying and evaluating structure and activity of promising organisms. Photograph from Kitasato Institute. Trends in Parasitology 2014 30, 445-455DOI: (10.1016/j.pt.2014.07.005) Copyright © 2014 Elsevier Ltd Terms and Conditions

Figure 2 Chemical development of ivermectin. Hydrogenation of avermectin B1, using Wilkinson's catalyst [RhCl(PPh3)3], selectively reduces the double bond at C22–23 (in red) to a single bond to form the more effective ivermectin. Trends in Parasitology 2014 30, 445-455DOI: (10.1016/j.pt.2014.07.005) Copyright © 2014 Elsevier Ltd Terms and Conditions

Figure 3 Samples of the key ivermectin market products. (A) Animal health products are primarily for livestock and pets. (B) Mectizan® is donated to treat onchocerciasis and lymphatic filariasis in humans where the two diseases coexist. (C) Stromectol® is a commercial tablet product used to treat strongyloidiasis and scabies in humans. Photographs by Andy Crump Trends in Parasitology 2014 30, 445-455DOI: (10.1016/j.pt.2014.07.005) Copyright © 2014 Elsevier Ltd Terms and Conditions

Figure 4 Community-directed treatment with ivermectin. After minimal training, village-based volunteers can distribute ivermectin to community members in their own homes at their joint convenience. Photograph by Andy Crump. Insert from Merck @ Co. Inc. Trends in Parasitology 2014 30, 445-455DOI: (10.1016/j.pt.2014.07.005) Copyright © 2014 Elsevier Ltd Terms and Conditions

Figure 5 Global ivermectin (Mectizan®) treatment trend. The number of treatments approved by the Mectizan Donation Programme (1987–2013). Trends in Parasitology 2014 30, 445-455DOI: (10.1016/j.pt.2014.07.005) Copyright © 2014 Elsevier Ltd Terms and Conditions

Figure 6 Ivermectin for poor communities. Is mass administration of ivermectin a viable public health strategy for the future? Photograph by Andy Crump. Trends in Parasitology 2014 30, 445-455DOI: (10.1016/j.pt.2014.07.005) Copyright © 2014 Elsevier Ltd Terms and Conditions