Medical treatment of cystic echinococcosis: systematic review and meta-analysis

Abstract

BackgroundCystic echinococcosis (CE) is a well-known neglected parasitic disease. However, evidence supporting the four current treatment modalities is inadequate, and treatment options remain controversial. The aim of this work is to analyse the available data to answer clinical questions regarding medical treatment of CE.MethodsA thorough electronic search of the relevant literature without language restrictions was carried out using PubMed (Medline), Cochrane Central Register of Controlled Trials, BioMed, Database of Abstracts of Reviews of Effects, and Cochrane Plus databases up to February 1, 2017. All descriptive studies reporting an assessment of CE treatment and published in a peer-reviewed journal with available full-text were considered for a qualitative analysis. Randomized controlled trials were included in a quantitative meta-analysis. We used the standard methodological procedures established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.ResultsWe included 33 studies related to the pharmacological treatment of CE in humans. Of these, 22 studies with levels of evidence 2 to 4 were qualitatively analysed, and 11 randomized controlled trials were quantitatively analysed by meta-analysis.ConclusionsTreatment outcomes are better when surgery or PAIR (Puncture, Aspiration, Injection of protoscolicidal agent and Reaspiration) is combined with benzimidazole drugs given pre- and/or post-operation. Albendazole chemotherapy was found to be the primary pharmacological treatment to consider in the medical management of CE. Nevertheless, combined treatment with albendazole plus praziquantel resulted in higher scolicidal and anti-cyst activity and was more likely to result in cure or improvement relative to albendazole alone.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3201-y) contains supplementary material, which is available to authorized users.

Knowledge, attitudes and practices regarding echinococcosis in Xizang Autonomous Region, China

“…CE is a chronic, complex disease and defined as a neglected tropical disease (NTD) by the World Health Organization (WHO) [12]. Four options for the treatment of CE are currently available: (1) surgery, (2) chemotherapy with albendazole, mebendazole or other anthelmintic drugs, (3) PAIR (puncture, aspiration, injection, reaspiration), (4) watch and wait for inactive or silent cysts [13]. At present, there is no optimum treatment for CE, and there are no clinical trials to compare the different modalities [14].…”

“…In addition, surgery is not suitable for patients with multiple cysts in several organs [2,14,17]. With the development and progress of medical technologies, CE can be diagnosed primarily utilizing imaging, immunology, molecular biology and puncture biopsy [13]. In the meantime, a large number of insecticides have been put into use, which has achieved certain results in reducing the incidence of CE [13].…”

“…With the development and progress of medical technologies, CE can be diagnosed primarily utilizing imaging, immunology, molecular biology and puncture biopsy [13]. In the meantime, a large number of insecticides have been put into use, which has achieved certain results in reducing the incidence of CE [13]. Longterm use of chemical drugs leaves other problems such as drug resistance, drug residues, environmental pollution, and so on [13].…”

“…In the meantime, a large number of insecticides have been put into use, which has achieved certain results in reducing the incidence of CE [13]. Longterm use of chemical drugs leaves other problems such as drug resistance, drug residues, environmental pollution, and so on [13].…”

Introductory Chapter: Overview on Echinococcosis

“…Drug therapy should be administered continuously for at least 3 months. However, prolonged treatment has a high cost with multiple teratogenic side effects [16]. Moreover, chemotherapy can be used as a complementary therapy to surgery or to prevent metastasis and secondary cystic sites.…”