Clinical Efficacy and Safety of Albendazole and Other Benzimidazole Anthelmintics for Rat Lungworm Disease (Neuroangiostrongyliasis): A Systematic Analysis of Clinical Reports and Animal Studies

Abstract

The safety and efficacy of benzimidazole anthelmintics for the management of rat lungworm disease (neuroangiostrongyliasis) have been questioned regardless of the numerous global experimental animal studies and clinical reports. In this review, 40 of these experimental animal studies and 104 clinical reports are compiled with a focus on albendazole. Among the 144 articles involving an estimated 1034 patients and 2,561 animals, 4.1% were inconclusive or vague regarding the use of benzimidazoles. Of the remaining 138 articles, 90.5% found benzimidazoles to be safe and effective (885 patients; 2,530 animals), 4.3% as safe but ineffective (73 patients; 3 animals), and 5.0% caused adverse reactions (7 patients; 28 animals). Among the clinical reports with a confirmed diagnosis of neuroangiostrongyliasis in which albendazole monotherapy was used, 100% reported high efficacy (743 patients; 479 animals), and in those where albendazole-corticosteroid co-therapy was used, 97.87% were reported to be effective (323 patients; 130 animals).

Inhibition of albendazole and 2‐(2‐aminophenyl)‐1H‐benzimidazole against tyrosinase: mechanism, structure–activity relationship, and anti‐browning effect

“…Clinical reports with a confirmed diagnosis reported albendazole monotherapy to be 100% effective (743 patients, 479 animals). In general, albendazole is recognized as a safe drug with low toxicity 51 . A previous report revealed that the oral LD 50 of albendazole in rat ranged from 1.32 to 2.4 g kg −1 52 .…”

Angie-LAMP for diagnosis of human eosinophilic meningitis using dog as proxy: A LAMP assay forAngiostrongylus cantonensisDNA in cerebrospinal fluid

“…One, however, has to consider if LAMP is a useful alternative diagnostic modality for clinical scenarios in both veterinary and medical settings. Infections with A. cantonensis are medical as well as veterinary emergencies that requires rapid intervention to alleviate the overt host response in the meninges as well as administration of antiparasiticides [24, 49]. Clinical signalment and signs associated with the syndrome often lead to presumptive diagnosis and initiation of treatment regardless of early laboratory data, as CSF collection can be financially prohibitive or not feasible due to the locations where these patients are situated.…”

Management of Rat Lungworm Disease (Neuroangiostrongyliasis) Using Anthelmintics: Recent Updates and Recommendations

“…Albendazole is a benzimidazole anthelmintic and, to date, is the most suitable anthelmintic for the management of neuroangiostrongyliasis due to its broad spectrum of nematocidal activity and ability to cross the blood–brain barrier (BBB) [ 18 ]. A systematic literature survey by Jacob et al (2022a) [ 19 ] on the clinical outcomes associated with benzimidazole treatment found no evidence of albendazole resulting in cerebral inflammation or exacerbation of symptoms among patients with confirmed diagnoses of neuroangiostrongyliasis. This survey included an estimated 1034 patients and 2561 animals and provides highly supportive evidence for the safe and effective use of albendazole–corticosteroid co-therapy.…”

“…This survey included an estimated 1034 patients and 2561 animals and provides highly supportive evidence for the safe and effective use of albendazole–corticosteroid co-therapy. The estimated dose of albendazole reported in these studies was approximately 15 mg/kg/day or 400 mg twice daily (with an average body weight of 60 kg) [ 19 ]. While bone marrow suppression and associated symptoms have been reported with long-term use of albendazole, overall, albendazole is generally considered to be a very safe anthelmintic [ 20 ].…”

“…While bone marrow suppression and associated symptoms have been reported with long-term use of albendazole, overall, albendazole is generally considered to be a very safe anthelmintic [ 20 ]. Furthermore, no such side effects have been reported among neuroangiostrongyliasis patients [ 19 ].…”