Effect of Albendazole on Recurrent and Residual Alveolar Echinococcosis of the Liver After Surgery

Abstract

palliative operations such as marsupialization with biliary drainage, Patients with alveolar echinococcosis of the liverand laparotomy were performed in 14, 5, and 1 cases, respectively.(AEL) can be cured by complete excision of the lesions;Mebendazole had been given before albendazole therapy in 9 cases. however, it is not always completely resectable in ad-Eight patients had lung metastasis, and 2 had lymph node metastavanced cases. Recently, benzimidazole-type drugs have sis. The staging system proposed by Nakajima et al. 10 was used.been reported to be effective in nonresectable AEL. One Five groups (I, II, IIIa, IIIb, and IV) are obtained according to three hundred fifty-two patients with AEL have been surgi-principal degrees of anatomic extent: apparent localization of the cally treated in our institution since 1937. Our clinical site of origin (occupied segments); evidence of regional spread to the adjacent tissue or organ, usually in the form of direct invasion; and trial with albendazole, one of the benzimidazole carba- A IIIb indicates, in addition to involvement of one to three segments, favorable response to albendazole, such as decreases in regional tissue or organ invasion and/or distant metastasis, but all the size of the lesions, changes in cyst morphology, and lesions should be resectable. Stage IV indicates intrahepatic lesions amelioration in clinical symptoms or signs, was achieved occupied in four segments and/or regional invasion and/or distant in 11 (55%) cases. These favorable responses were also metastasis of which every lesion is nonresectable (i.e., curative operation cannot be achieved).10 Advanced stages were seen frequently; seen in cases of noncurative resection and palliative opthere were 1, 3, 4, 6, and 12 cases in stages I, II, IIIa, IIIb, and IV, eration. The cumulative survival rate of the patients was respectively. 87%, 15 years after the operation. A complete responseHematological examination and liver function tests were perwas achieved in one case; the residual lesion in the liver formed every 2 weeks, and serological tests and ultrasound (US) and completely disappeared on the computed tomography computed tomography (CT) scans were carried out at approximately image 3.5 years after noncurative surgery. Palliative or 6-month intervals. The drug protocol for albendazole (200-mg tablets; mass reduction surgery combined with albendazole obtained from SmithKline Beecham, Tokyo, Japan) was 10 mg/kg/d therapy may be a strategy for advanced disease, espe-orally in a treatment cycle of 4 weeks with 2-week breaks.3 This cycle cially when complete resection might result in signifi-was repeated indefinitely unless there were adverse reactions. The average duration of treatment was 3.25 years. cant morbidity or mortality. (HEPATOLOGY 1997;25:The study protocol of chemotherapy was approved by the ethics 528-531.)committee of the Department of Medicine of Hokkaido University. Chemotherapy was performed in patients after their informed conPatients with alveolar echinococcosis of the live...

In Vitro Activities of Itraconazole, Methiazole, and Nitazoxanide versus Echinococcus multilocularis Larvae

“…Severe side effects may be observed, and the parasitostatic effect of these drugs implies that E. multilocularis is not depleted and may resume growth after discontinuation of treatment (3,18). The overall success rate of benzimidazole treatment ranges between 55 and 97% (4,9,19). As an alternative, conventional amphotericin B desoxycholate (cAMB) effectively inhibits larval growth (20).…”

Structured treatment interruption in patients with alveolar echinococcosis

“…Early clinical symptoms are lacking and most cases are diagnosed at late stages with unresectable hepatic lesions. 1 At present, these cases of late diagnosis require lifelong pharmacological treatment with benzimidazoles-albendazole (ABZ) or mebendazole (MBZ)-and thorough follow-up, 2,3 because benzimidazoles are assumed to exert only a parasitostatic effect on E. multilocularis. 4 Recent case reports emphasize the possibility of parasite death under benzimidazole treatment, implying a parasitocidal effect of benzimidazoles.…”

Alveolar Echinococcosis in Turkey

“…Otherwise, the risk of recurrence due to latent microcysts in the surgical margin is increased [7, 17, 18, 19]. Unfortunately, this approach cannot be implemented in a significant majority of the patients as reflected by the wide spectrum of the resectability rates reported in the literature (4–87%) [7, 8, 9, 10, 11, 20, 21].…”