Chemotherapy of Echinococcus infection in man with albendazole

Since 1983 data have been collected on the outcome of treatment of apparently active Echinococcus granulosus hydatid cysts with albendazole. Most patients received 800 mg albendazole daily in cycles of 28 d with 14 d between cycles, with a mean duration of 2.5 cycles (range 1-12). From an initial set of over 500 cases, 253 patients were evaluated for efficacy, with 269 hepatic, 86 pulmonary, 50 peritoneal and 51 cysts at other sites being individually assessed. 72 patients (28.5%) were regarded as cured, 129 (51%) as improved, 46 (18.1%) as unchanged and 6 (2.4%) were worse. 47 patients underwent surgery after treatment and viability was demonstrated in only 5 cysts (10.6%). Recurrence was observed in 4 of 29 non-surgical cases (13.8%) from whom a follow-up of at least 24 months was available. 35 cases of E. multilocularis infection were assessed, with cure in 2, improvements in 4, stabilization in 25 and progression in 4 cases. Side effects of treatment were uncommon. Liver function abnormalities occurred in about 20% (4% withdrawn) and there was a tendency for leucopenia to occur in E. multilocularis patients. Albendazole appears to be effective both for chemotherapy in inoperable cases of hydatid disease and for prophylaxis before surgery.