Three monthly doses of 60 mg/kg praziquantel for Schistosoma haematobium infection is a safe and effective treatment regimen

Abstract

Background: Praziquantel (PZQ) is the standard treatment for Schistosomiasis in sub-Saharan Africa. However, there is evidence suggesting praziquantel treatment failure in Schistosome infections with associated potential renal impairment. The objective of this study was to determine the effect of three monthly doses of 60 mg/kg/day PZQ on schistosome egg count, liver and renal function during the treatment of urinary schistosomiasis in Ghana. Methods: A nested case-control study was designed from a cohort screened for schistosomiasis; 28 schistosomiasis positive cases by microscopy matched with 53 healthy controls by age and gender. The study population was urban dwellers from the Asokwa sub-metropolitan area, Kumasi in Ghana. Participants were within the age range of 6 to 30 years. We assessed Schistosoma haematobium egg counts in urine and its associated impact on liver and renal function at baseline, treatment and post-treatment phases using serum. Results: Of the 28 cases and 53 controls, 78.6% and 81.1% were males respectively. Globulin levels before treatment was higher in cases [36.7 (32.8, 40.1) vrs 30.5 (22.4, 33.8), p = 0.005] at pre-treatment but not at post-treatment [35.8 (31.2, 39.1) vrs 37.4 (29.7, 43.0), p = 0.767]. Estimated cure rate was 42.9, 46.4 and 96.4% after first, second and third dose respectively. Schistosome egg counts dropped significantly (p = 0.001) from before second dose to post-treatment. Similarly, levels of alanine aminotransferase (p = 0.001), aspartate aminotransferase (p = 0.028) and gamma glutamyl transferase (p = 0.001) significantly declined towards post-treatment. Estimated glomerular filtration rate significantly improved from before second dose to post-treatment using both the Chronic Kidney Disease Epidemiology Program (p = 0.001) and 4-variable Modification of Diet in Renal Disease (p = 0.002) equations. Conclusion: Treatment of urinary Schistosoma hematobium infections with a repeated high monthly dose of 60 mg/kg of praziquantel for 3 months is safe and effective.

Point-of-care circulating cathodic antigen positivity and associated factors in school children one year after mass praziquantel administration in an endemic district in Ghana

“…This is because several studies have demonstrated that praziquantel reduced fertility in the Schistosome [ [36] , [37] , [38] , [39] ]. Aside the reduced fecundity imposed on the Schistosome possibly by praziquantel, treatment failure has also been widely reported [ 14 , 19 , 20 ]. Again, egg negative Schistosome could be due to the presence of immature or menopausal worms, presence of all male or all female parasites in the study participants and excretion of eggs on a different day [ 40 ].…”

“…However, several cases of therapeutic failure of praziquantel used for the treatment of schistosomiasis have been reported [ 14 ]. Praziquantel treatment failure in both urinary and intestinal schistosomiasis have been reported in Spain [ 15 ], Italian returnees from Uganda [ 14 ], Senegal [ 16 ], Egypt [ 17 , 18 ], Malawi [ 19 ] and Ghana [ 20 ]. These studies underscore the importance of assessments of the efficacy of praziquantel administration after treatment.…”

Diagnosis and management of complicated urogenital schistosomiasis: a systematic review of the literature

“…A single case–control study, intended to examine the safety of three monthly doses of 60 mg/kg PZQ and their efficacy in reducing the eggs count, also examined the effect of this therapy on kidney function of 28 S. haematobium -infected patients with no renal damage. The study showed improvements of post-treatment organ function (increase of the eGFR) without significant adverse effects [ 116 ].…”

An effective proposal plantherapy forthe treatment of schistosomiasisinTaiz Governorate

“…The number of patients Treatment testsfor schistosomiasis were performed on 450 patientsand the group of patients was divided into three groups, each group 150 patients and each group was given a treatment plan. The first group was given according to the general protocol praziquantel 40 mg per kg as a single dose, which is the most used method of treatment [16] and the results were 40 cases out of 150 patients that were cured and this method of treatment was applied in Egypt through the comprehensive treatment program praziquantel. Before treatment, the prevalence of schistosomiasis in villages ranged from more than 30% to 10% to 20% and after using the treatment the prevalence of treatment decreased to less than 3% [17].…”