Prospects in medical management of Echinococcus granulosus

Both benzimidazoles (albendazole) and isoquineline compounds (praziquantel) have activity against. We reviewed the efficiency of benzimidazole and isoquineline in the management of hepatic Echinococcus in our clinical cases and the other laboratory and animal studies. Until recently, surgery was the only treatment of choice. Albendazole introduction and its early results were exciting. In 1985, a favorable outcome of a combination of albendazole and praziquantel was described and lately indications for pre- and postoperative prophylactic usage has been established. Both drugs in animal and laboratory studies by different authors and our own clinical experiences were reviewed and the effectiveness for both therapeutic and prophylaxis purposes were studied. Albendazole in the treatment of Echinococcus granulosus is shown to be superior to other benzimidazoles and a combination of albendazole and praziquantel is more effective than albendazole alone. Albendazole therapy is associated with a 50% disappearance of cysts and in others has caused shrinkage, cyst wall and interacystic changes. Pre- and postoperative prophylactic therapy is effective and side effects with regular follow-up and evaluation are not serious. Long-term follow-up showed a 30% recurrence rate, whereas, in contrast, combination therapy required a shorter period of therapy but long-term outcome and recurrence are still to be evaluated. In conclusion chemotherapy is an essential part of management. Combination therapy is more effective and requires a shorter period of treatment than albendazole alone. Pre- and postoperative prophylactic therapy reduce risk of spillage and dissemination during surgery and percutaneous aspiration. Chemotherapy failure could be due to a number of factors such as pharmacokinetics and queries different strains of parasites which should not prevent its usage as an essential part of management.