Alveolar echinococcosis (AE) is caused by the metacestode stage of the fox tapeworm Echinococcus multilocularis and causes severe disease in the human liver, and occasionally in other organs, that is fatal when treatment is unsuccessful. The present chemotherapy against AE is based on mebendazole and albendazole. Albendazole treatment has been found to be ineffective in some instances, is parasitostatic rather than parasiticidal, and usually involves the lifelong uptake of large doses of drugs. Thus, new treatment options are urgently needed. In this study we investigated the in vitro and in vivo efficacy of mefloquine against E. multilocularis metacestodes. Treatment using mefloquine (20 M) against in vitro cultures of metacestodes resulted in rapid and complete detachment of large parts of the germinal layer from the inner surface of the laminated layer within a few hours. The in vitro activity of mefloquine was dependent on the dosage. In vitro culture of metacestodes in the presence of 24 M mefloquine for a period of 10 days was parasiticidal, as determined by murine bioassays, while treatment with 12 M was not. Oral application of mefloquine (25 mg/kg of body weight administered twice a week for a period of 8 weeks) in E. multilocularis-infected mice was ineffective in achieving any reduction of parasite weight, whereas treatment with albendazole (200 mg/kg/day) was highly effective. However, when the same mefloquine dosage was applied intraperitoneally, the reduction in parasite weight was similar to the reduction seen with oral albendazole application. Combined application of both drugs did not increase the treatment efficacy. In conclusion, mefloquine represents an interesting drug candidate for the treatment of AE, and these results should be followed up in appropriate in vivo studies.In humans, infection with the larval stage of Echinococcus multilocularis causes alveolar echinococcosis (AE), a mainly hepatic disease, which is fatal if not treated appropriately. E. multilocularis metacestodes proliferate asexually by forming small daughter vesicles, leading to a parasite mass that exhibits tumor-like properties and progressively infiltrates the neighboring tissue (8). The treatment options for AE are surgery and/or chemotherapy. Surgery is, of course, an invasive procedure, and feasibility depends on the location of the metacestode tissue. In addition, care must be taken to remove the entire parasite mass (otherwise, recurrences are certain), and there is the risk of metastasis formation caused by accidental dissemination of small daughter vesicles or even parasitic cells. Surgery is always accompanied by pre-and postoperative chemotherapy. In cases where surgery is not possible, chemotherapy remains the only option. For chemotherapeutical treatment of AE, the only two drugs licensed to date are the benzimidazole carbamate derivatives albendazole and mebendazole (42). However, therapy using these drugs does not result in parasiticidal activity in vivo or in vitro, and treatment failures and/or the occu...