Treatment of Schistosomiasis

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

First-Line Treatment Recommendations

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
For Schistosoma hematobium infection: Praziquantel 40 mg/kg orally as a single dose 2

Occurs 2-8 weeks after exposure to contaminated water, presenting with fever, urticarial rash, dry cough, and eosinophilia 3, 1
Treatment approach:
- Praziquantel 40 mg/kg as a single dose should be given at the time of diagnosis 3
- Treatment should be repeated after 6-8 weeks as eggs and immature schistosomules are relatively resistant to initial treatment 3, 1
- A short course of oral prednisolone 20 mg/day for 5 days is recommended to reduce symptom duration 3, 1

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

High-quality evidence shows that a single 40 mg/kg dose of praziquantel reduces egg excretion by over 95% in most cases 4
Cure rates vary substantially between studies, ranging from 22.5% to 83.3%, but typically exceed 60% 4
Serology may remain positive for years after successful treatment and cannot be used to assess treatment success 1, 2
For patients with persistent infection after standard treatment, consider:
- Repeating praziquantel treatment (a third dose has shown 80% efficacy in previously uncured patients) 5
- Evaluating for potential co-infections that may affect treatment response 2

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
Not considering potential co-infection with strongyloidiasis before starting corticosteroids, which could precipitate hyperinfection syndrome 1
Not repeating treatment after 6-8 weeks in acute schistosomiasis cases, as immature forms may survive initial treatment 3

Common side effects of praziquantel include abdominal pain, dizziness, and diarrhea 6
Side effects are generally mild and transient 5
Splitting the 40 mg/kg dose into two doses over 12 hours offers no benefits over a single dose and may increase side effects like vomiting and dizziness 4

For patients with elevated serum creatinine and/or hematuria, evaluate for bladder cancer and/or urinary obstruction, which are common complications of S. hematobium infection 2
Consider testing for appropriate endemic coinfections, such as Salmonella, HBV, HCV, and HIV, as targeted treatment of these may alter the course of schistosomiasis complications 2
Monitor patients with hepatic fibrosis from schistosomiasis for the development of kidney disease 2