Epidemiological basis for chemotherapy of human echinococcosis

Cystic (E. granulosus) echinococcosis is an important medical problem in Mediterranean countries where the dog-sheep-dog strain predominates. This mainly man-made infection is susceptible to control programmes directed against the infections in dogs. In man, surgery still remains a major curative intervention. Some benzimidazole compounds (mebendazole, albendazole) are effective in some cases of cystic echinococcosis, however, further studies on more effective drugs are recommended. At present chemotherapy should be used only in inoperable cases of cystic echinococcosis in man. Alveolar (E. multilocularis) echinococcosis is diagnosed more and more frequently in some regions of Central Europe. Man cannot interfere much with the reservoir of E. multilocularis in wild life, but should be able to protect himself and his dogs against infection from natural foci. High doses of mebendazole taken continuously have shown to increase substantially the survival rate of infected patients. However, further studies are needed to improve the efficacy of chemotherapy and to make it available to all those patients who have not been cured by surgery.