Therapy of human hydatid disease with mebendazole and albendazole

Abstract

We report our experience in the treatment with benzoimidazole carbamates (mebendazole and albendazole) of 337 patients affected by hydatid cysts with different localizations. The treated cysts showed degenerative modifications in 50.6% of the cases after mebendazole treatment and in about 80%o after albendazole treatment. Relapses after therapy were observed in 30%o of the cases; about 95% of the recurring cysts showed good susceptibility to a further cycle of therapy with benzoimidazole carbamates. Side effects observed with either drug were not severe and always reversible, consisting mainly of abdominal pains and increased levels of transaminases in serum. Among the factors that may influence the therapeutic results are the drug employed, the age of the cysts, the age of the patient, and the localization of the cysts and their morphological characteristics. Moreover, it can be hypothesized that each hydatid cyst has an intrinsic sensitivity to benzoimidazole carbamates.

Effect of dose increase or cimetidine co-administration on albendazole bioavailability.

“…19 Despite its poor absorption, albendazole is also used for the treatment of systemic parasitic infections like echinococcosis because alternative drugs are not available. [2][3][4] In most pharmacokinetic studies designed to investigate how to increase the concentrations of the active metabolite ABZSX, intra-individual and inter-individual variability was high. [13][14][15] Our data show a similar pattern.…”

“…Albendazole is an effective drug for treatment of these diseases but the therapeutic response in echinococcosis is poorly predictable due to the poor bioavailability. [1][2][3][4] After intestinal absorption, the drug is rapidly converted by the liver and probably also by mucosal cells into the active metabolite ABZSX, a mixture of R(ϩ) and S(Ϫ) enantiomers. Formation of R(ϩ)ABZSX is catalyzed by microsomal flavin monooxidase (FMO) and of S(Ϫ)ABZSX by cytochrome P450 enzymes (CYP3A).…”

Hydatid Disease: Current Status and Recent Advances

“…Imidazoles are hepatotoxic, can cause neutropenia, thrombocytopenia, alopecia and are potentially embryotoxic and teratogenic. 11,[36][37][38][39][40][41] Recently, percutaneous drainage of hepatic hydatid cysts, popularly known in Europe as the PAIR (Puncture, Aspiration, Installation of scolicidal agent and Reaspiration) technique has gained acceptance. [42][43][44][45][46][47][48] The procedure is minimally invasive, cost-effective, involves reduced hospital stay and has less morbidity and mortality than surgery.…”

Immunological markers indicating the effectiveness of pharmacological treatment in human hydatid disease

“…In humans, the larval forms develop into large cysts especially in the liver, lung and brain. The therapy of hydatidosis is primarily surgical, even though pharmacological treatment with benzoimidazole carbamates is nowadays a suitable alternative [1]. The variability and severity of the clinical expression of this parasitosis probably refiect not only the duration and intensity of infection, but also the variety of human immunological responses to parasite antigens.…”