Albendazole in treatment of human cystic echinococcosis: 12 years of experience

Abstract

This review paper examines the evidence from published and previously unpublished sources for the efficacy and safety of albendazole (ABZ) obtained in the last 12 years. Benzimidazole treatment alone is not ideal, requiring prolonged administration over many weeks, with an unpredictable outcome in terms of response rates in individuals. However, studies have shown that treatment with albendazole in E. granulosus infection can result in an apparent cure in up to 30% of cases, with a further 40-50% showing objective evidence of response when followed in the short term. Some studies have demonstrated that even patients who do not show obvious initial evidence of response may be found to be cured when followed up over several years. Duration of therapy and dose are also important, and with ABZ, efficacy seems to increase with exposure up to 3 months in the commoner cyst sites. Formal dose ranging and minimal effective dose studies have not been performed, but the current dose of 800 mg daily appears to be adequate. The issue of cyclical versus continuous treatment still has to be resolved. Data on ABZ safety has been accumulated over the past 12 years of marketing. The profile shows that liver function abnormalities are common although rarely treatment limiting, while occasional hematological changes affecting the white cells may be more serious. The safety data supplies the rationale for monitoring of patients during treatment. On balance ABZ has been shown to be a useful advance in the management of cystic echinococcosis both when used as sole treatment or as an adjunct to surgery or other treatments.