Treatment of Schistosomiasis (Bilharzia)

Praziquantel is the drug of choice for treating all forms of schistosomiasis, with dosing based on the infecting Schistosoma species. 1

First-Line Treatment Regimens

For Schistosoma mansoni, S. intercalatum, and S. guineensis infections: Praziquantel 40 mg/kg orally as a single dose 1
For Schistosoma japonicum and S. mekongi infections: Praziquantel 60 mg/kg orally in two divided doses 1
For infections diagnosed by serology alone from the Asia-Pacific region: Praziquantel 60 mg/kg orally in two divided doses 1
Treatment must be administered in sufficient dosage and duration to completely eradicate the organism 2, 3

Occurs 2-9 weeks after fresh water exposure in Africa (occasionally SE Asia, South America, Arabian peninsula) 2
Presents with eosinophilia, fever, dry cough, and urticarial rash 2
Treatment approach:
- Praziquantel 40 mg/kg as a single dose, repeated at 6-8 weeks (as eggs and immature schistosomules are relatively resistant) 2
- Corticosteroids (prednisolone 20 mg/day for 5 days) to reduce symptom duration 2, 1
- Administer praziquantel after the acute inflammatory phase 1

Praziquantel 40 mg/kg twice daily for 5 days for CNS involvement 1
Combine with dexamethasone 4 mg four times daily, reducing after 7 days, for a total of 2-6 weeks 1
Corticosteroids should be given first, before anthelmintic therapy in acute cases 1

Test for endemic coinfections (Salmonella, HBV, HCV, HIV) as targeted treatment may alter disease course 2, 3
No immunosuppressive agents are indicated in schistosomal nephropathy 2, 3
Evaluate patients with elevated serum creatinine and/or hematuria for bladder cancer and/or urinary obstruction 3

Diagnosis is confirmed by finding eggs in stool or urine samples 4, 5
During acute phase (Katayama syndrome), serology and stool/urine microscopy have low sensitivity 2
Consider kidney biopsy in patients with overt or progressive kidney disease, but can defer in mild disease 2, 3

Serology may remain positive for many years after successful treatment and cannot be used to assess treatment success 1, 3
Monitor patients with hepatic fibrosis from schistosomiasis for the development of kidney disease 3

Failing to adjust dosage based on Schistosoma species can lead to treatment failure 1
Using serology alone to assess treatment success is unreliable as antibodies persist for years 1
Administering praziquantel during acute Katayama syndrome without steroids may worsen symptoms 1
Consider potential co-infection with strongyloidiasis before starting corticosteroids, which could precipitate hyperinfection syndrome 1

Vaccine development is in progress but not yet available for clinical use 6, 7
Integrated control targeting the life cycle is necessary for sustainable elimination 7
Concerns about potential drug resistance with increased praziquantel usage in mass drug administration programs 6