From the Guidelines
Combination therapy with albendazole and praziquantel is indicated in echinococcosis for complicated cases, such as large or multiple cysts, or when there is a risk of cyst rupture during surgical interventions, with the addition of praziquantel (20 mg/kg bd) for 2 weeks pre and post aspiration or surgery, as recommended by the WHO Informal Working Group on echinococcosis 1.
Key Considerations
- The WHO Informal Working Group on echinococcosis has developed a classification of ultrasound appearances of cysts, which guides treatment according to cyst size, location, and stage 1.
- Albendazole alone is recommended for cysts <5 cm in size, while combination therapy with albendazole and praziquantel is considered for larger or more complex cases 1.
- The standard regimen involves albendazole (400 mg bd) with the addition of praziquantel (20 mg/kg bd) for 2 weeks pre and post aspiration or surgery, as recommended by the WHO Informal Working Group on echinococcosis 1.
Treatment Approach
- Surgical or endoscopic removal of the worm is recommended, with percutaneous interventions only carried out in specialist centers 1.
- Puncture, aspiration, injection, and re-aspiration (PAIR) together with drug therapy is recommended for simple liver cysts (stage 1) 5 cm in diameter 1.
- Late-stage cysts (WHO type 4 or 5) may be treated by careful observation with sequential ultrasound scans 1.
Important Considerations
- Patients should be monitored for hepatotoxicity with liver function tests every 2-4 weeks during treatment 1.
- The medication should be taken with fatty meals to enhance absorption 1.
From the Research
Indications for Combination Therapy
- Combination therapy with albendazole and praziquantel may be indicated in certain situations, such as in the treatment of cystic echinococcosis (CE) 2.
- The World Health Organization (WHO) diagnostic classification can help guide the management options for CE, and combination therapy may be preferred in some cases 2.
- Combination therapy can be used as adjunctive treatment to surgery and percutaneous treatment 2.
Efficacy of Combination Therapy
- Combined chemotherapy with albendazole and praziquantel was found to be more effective than either of the agents given alone 3, 4.
- A case report showed that combined albenazole-praziquantel treatment achieved a 3-year remission in a patient with recurrent brain echinococcosis 5.
- Studies have shown that albendazole is superior to other benzimidazoles, and combination therapy with praziquantel is more effective than albendazole alone 4.
Specific Situations for Combination Therapy
- In some cases, combination therapy may be preferred for the treatment of small (<5 cm) WHO stage CE1 and CE3a cysts 2.
- Combination therapy can be used as pre- and postoperative prophylactic treatment to reduce the risk of spillage and dissemination during surgery and percutaneous aspiration 4.
- The use of a higher dose of albendazole (15 mg/kg/day) combined with praziquantel may be effective in achieving a more pronounced protoscolex inactivation and reducing the risk of disease recurrence 5.