Alveolar echinococcosis is caused by the parasitic cestode Echinococcus multilocularis. Benzimidazoles, namely, mebendazole and albendazole, are the only drugs available for the treatment of inoperable alveolar echinococcosis. At present, no therapeutic alternative is available for patients with progressive disease under treatment or for patients who are unable to tolerate the side effects of the benzimidazoles. In addition, benzimidazoles are only parasitostatic for E. multilocularis. Thus, new therapeutic options are of paramount importance. In the present study we examined the in vitro effect of amphotericin B on E. multilocularis larvae. E. multilocularis metacestodes grown in the peritoneal cavities of Mongolian gerbils were transferred into a culture system. Vesicles budded from the tissue blocks and increased in number and size during the first 5 weeks. After 6 weeks drugs were added and deleterious effects on the vesicles were observed macroscopically and microscopically. By use of this in vitro tissue culture model we demonstrated that amphotericin B effectively inhibits the growth of E. multilocularis metacestodes. This destructive effect was significantly more rapid with amphotericin B than with the benzimidazoles. Cyclic treatment was effective in suppressing parasite growth. However, amphotericin B appears to be parasitostatic for E. multilocularis larvae, and regrowth occurs even after extended periods. In summary, amphotericin B constitutes the first promising alternative for the treatment of alveolar echinococcosis in cases of intolerance or resistance to benzimidazoles. It holds promise as an effective treatment option for otherwise fatal courses of disease.The larval stage of Echinococcus multilocularis causes alveolar echinococcosis (AE), a parasitic disease primarily affecting the liver. Human AE is endemic in regions of Western and Central Europe, Eastern Europe, North America, and Asia. Untreated AE is fatal in over 90% of cases, and surgical resection is often incomplete due to the diffuse infiltration of nonresectable structures.Benzimidazole carbamate derivatives, namely, mebendazole (MBZ) and albendazole (ABZ), are the only drugs available for the treatment of human AE. A disadvantage of the benzimidazoles is the fact that these drugs are parasitostatic rather than parasitocidal for E. multilocularis (5,6,36). This implies that the parasite is not depleted and may resume growth after discontinuation of treatment. Thus, benzimidazoles must be taken life long for the treatment of AE. The overall success rate of benzimidazole treatment ranges between 55 and 97% (6,19,24,32). Failure may be due to severe side effects, such as liver toxicity, forcing a discontinuation of the medication (11). Another cause of failure is progressive disease, despite benzimidazole treatment, observed in up to 16% of cases (6).At present, no reliable chemotherapeutic alternative can be offered to patients who do not tolerate or do not respond to benzimidazoles. Thus, it has become evident that new chemotherapeut...