Short course albendazole treatment for neurocysticercosis in Columbia

Abstract

The efficacy of albendazole was evaluated in 20 Colombian patients with neurocysticercosis showing neurological symptoms. All had parenchymal non-enhancing cystic images by computerized tomography and a positive enzyme-linked immunosorbent assay for cysticercus antibodies in serum or cerebrospinal fluid. They stayed in hospital for 8 d during treatment with albendazole, 15 mg/kg/d in 2 divided doses, and were then followed for at least 6 months after treatment. The number of cysts was reduced by 50% after 6 months. In 7 (35%) all cysts disappeared, in 7 (35%) the number was reduced, and in the remaining 6 (30%) the number was unchanged. In the 13 patients who still had cysts at 6 months, 11 showed a moderate decrease in average cyst size and in 2 the size was unchanged. Side effects during treatment were observed in 60% of the cases, but only 3 required corticosteroids.

Efficacy of combined antiparasitic therapy with praziquantel and albendazole for neurocysticercosis: a double-blind, randomised controlled trial

“…10,11 This trial showed that combined albendazole plus praziquantel—and increased albendazole (although to a less degree)—kills more cysts than does standard-dose albendazole. This increase in efficacy did not occur in patients with one to two cysts.…”

“…Cyst damage is likely to lead to the release of parasite antigens and boost the immune response attack, in a process that involves an effect of praziquantel. We selected the combination of albendazole and praziquantel on the basis of their individual efficacy against cysticercosis, 6–11 different mechanisms of action, 12,13 findings from previous in-vitro and animal studies, 26,27 series of treatment of hydatid disease, 28 and findings from early studies in neurocysticercosis. 18,19 In our initial pharmacokinetics study, albendazole concentrations increased by roughly 50% in the combined treatment group, 14 thus we added an increased albendazole group to this trial.…”

“…6–9 However, antiparasitic treatment has suboptimum efficacy, killing roughly 65% of parasites and obtaining complete cyst resolution (no viable parasites remaining) in less than 40% of patients after a course of praziquantel or albendazole. 10,11 …”

Current Consensus Guidelines for Treatment of Neurocysticercosis

“…Instead, the dose previously used in hydatid disease (15 mg/kg/day) was used for cysticercosis. The initial length of therapy was 1 month, later reduced to 15 days and 1 week (2,3,14,21,29,55,63,89,90,94,95,98,111). There is limited experience with higher doses of both drugs (1,11,58).…”

Efficacy of Diverse Antiparasitic Treatments for Cysticercosis in the Pig Model

“…12 However, ABZ only kills approximately 70% of cysts and clears all living parasites in only 30% to 40% of treated patients after a course of treatment. 7,13,14 On the basis of previous successful studies of pig treatment with oxfendazole (OFZ), this controlled study was developed to explore the efficacy of combined therapy (ABZ plus PZQ) versus ABZ or PZQ alone. Nitazoxanide (NZX), a broad-spectrum drug with activity against a wide variety of intestinal parasites in animals and humans 15,16 was also evaluated.…”