Is schistosomiasis treated with corticosteroids (steroids) first, then anti-parasitic medications?

From the Guidelines

No, schistosomiasis is not typically treated with corticosteroids first, then anti-parasitic medications, but rather praziquantel is the primary treatment, with corticosteroids potentially used as an adjunct in certain cases, such as Katayama syndrome, as suggested by studies 1. The primary treatment for schistosomiasis is praziquantel, an anti-parasitic medication, which is typically given as a one-day treatment at a dose of 40-60 mg/kg divided into two or three doses.

• The most recent and highest quality study, 1, recommends praziquantel PO 40 mg/kg as a single dose for S. mansoni, S. intercalatum and S. guineensis infections, and 60 mg/kg in two divided doses for S. japonicum and S. mekongi infections.
• Corticosteroids may be used in certain complicated cases, such as neuroschistosomiasis or severe hypersensitivity reactions, but only as an adjunct to anti-parasitic therapy, not as initial treatment, as noted in 1 and 1.
• Praziquantel works by damaging the parasite's tegument (outer covering), causing paralysis and death of the worms, allowing the body's immune system to eliminate them.
• Treatment is generally well-tolerated, with mild side effects like abdominal pain, dizziness, or headache that typically resolve quickly.
• Follow-up stool or urine examinations may be needed 1-3 months after treatment to confirm cure, and retreatment may occasionally be necessary. Some key points to consider when treating schistosomiasis include:
• The diagnosis is often made based on a combination of clinical presentation, serology, and microscopy of concentrated stool samples.
• The treatment regimen may vary depending on the species of schistosome and the severity of the infection.
• Corticosteroids, such as prednisolone, may be used to alleviate acute symptoms in cases of Katayama syndrome, as suggested by 1 and 1.

From the Research

Treatment of Schistosomiasis

• The primary treatment for schistosomiasis is anti-parasitic medication, with praziquantel being the most commonly used drug 2, 3, 4, 5, 6.
• Praziquantel is effective against all major forms of schistosomiasis, although it is less active against juvenile than mature parasites 6.
• There is no evidence to suggest that corticosteroids (steroids) are used as a first-line treatment for schistosomiasis, followed by anti-parasitic medications.

Use of Corticosteroids

• Corticosteroids are not mentioned as a treatment for schistosomiasis in the provided studies 2, 3, 4, 5, 6.
• The focus of treatment is on anti-parasitic medications, such as praziquantel, metrifonate, and other drugs 3, 4, 5.

Anti-Parasitic Medications

• Praziquantel is the most studied drug for treating urinary schistosomiasis and has the strongest evidence base 3.
• Metrifonate is also effective in treating urinary schistosomiasis, although it may require multiple administrations 3, 5.
• Other anti-parasitic medications, such as oxamniquine and artesunate, have been evaluated, but their effectiveness is less well established 3, 4, 5.