Comparison of therapeutic regimen of anticysticercal drugs for parenchymal brain cysticercosis

Abstract

The efficacy of different regimens of therapy for parenchymal brain cysticercosis either with praziquantel (PZQ) or with albendazole (ALB) was compared in 114 patients. Four schemes of treatment were used: PZQ 50 mg/kg per day for 15 days, PZQ 50 mg/kg per day for 8 days, ALB 15 mg/kg per day for 30 days, and ALB 15 mg/kg per day for 8 days. Three months after therapy, it was apparent that both PZQ and ALB were effective, as shown by the disappearance of cystic lesions in computed tomographic scans. Thirty-three control patients followed for a mean of 11 months had no spontaneous remission of lesions. When comparing PZQ with ALB, the latter was found to be more effective than the former for both the full and the short course of treatment: 85% vs 60% and 85% vs 48% disappearance of lesions, respectively (P less than 0.001). Comparison of the full vs the short course of PZQ showed that the short course had a further 12% reduction in drug effectiveness. In contrast, the length of ALB therapy could be shortened without lessening its efficacy. Based on these results, an 8-day course of ALB is recommended as treatment for parenchymal brain cysticercosis; a 15-day course of PZQ could be subsequently used in those patients who show only partial response to ALB.

Review of neurocysticercosis

“…35,68 Albendazole destroys 75 to 90% of parenchymal brain cysts and has been shown to be superior to praziquantel in several comparative trials. 11,62,64,73 Another advantage of albendazole over praziquantel is that the former also destroys subarachnoid and ventricular cysts because of its better penetration in CSF, as well as the fact that it can be administered jointly with corticosteroid agents for antiinflammatory therapy. 12,23,48 The introduction of praziquantel and albendazole has radically changed the prognosis in most patients with NCC.…”

A 37-year-old Man with a Painless Growing Mass of the Thorax

“…In these cases, systemic therapy, for example, with antiparasitic drugs, such as praziquantel and albendazole, should be used [4,6,14]. Praziquantel (50 mg/kg per day for approximately 3 weeks) is reportedly effective and is considered the preferred drug for treatment of cysticercosis, although some studies indicate albendazole (10-15 mg/kg per day for approximately 2 weeks) shows better response rates [6,21].…”

Circulating parasite antigen in patients with hydrocephalus secondary to neurocysticercosis.

“…[27][28][29][30] Evidence provided in recent years strongly suggests that antiparasitic drugs are effective in killing subarachnoid and ventricular cysticerci. 22,[31][32][33] The antigen-positive hydrocephalus patients may potentially benefit from antiparasitic therapy, although a warning must be issued to carefully exclude the presence of cysts in the fourth ventricle or in other locations where the inflammatory reaction secondary to parasite death may cause life-threatening acute CSF blockage.…”