Clinical Infectious Diseases Advance Access published March 16, 2016
1 Cysticidal Efficacy of Combined Treatment with Praziquantel and Albendazole for
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Parenchymal Brain Cysticercosis
Hector H. Garcia1,2, Andres G. Lescano2,3, Isidro Gonzales1, Javier A. Bustos2, E. Javier Pretell4, John Horton5, Herbert Saavedra1, Armando E. Gonzalez6, and Robert H.
Unit, Department of Transmissible Diseases, Instituto Nacional de Ciencias
2Department
an
Neurologicas, Jr. Ancash 1271, Barrios Altos, Lima 1, Perú
of Microbiology, School of Sciences (HHG), Center for Global Health (HHG, JAB),
and School of Public Health (AGL), Universidad Peruana Cayetano Heredia, Av. H.
3Department
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Delgado 430, SMP, Lima 31, Perú
of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Av.
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Venezuela c.36 s/n, Bellavista, Callao, Peru 4Hospital
Nacional Alberto Sabogal, ESSALUD, Callao, Peru
5Tropical
Projects, 24 Paddock, Hitchin Herts SG4 9EF, England, UK
6School
of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Av. Circunvalacion
s/n, Salamanca de Monterrico, Ate, Lima, Perú of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N.
ce
7Department
Ac
Wolfe Street, Baltimore, MD 21205, USA
Corresponding Author. Hector H. Garcia, MD, PhD. Department of Microbiology, School of Sciences, and Center for Global Health, Universidad Peruana Cayetano Heredia, H. Delgado 430, SMP, Lima 31, Perú. Tel +511 3287360, Fax +511 3284038, email
[email protected]
© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
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1Cysticercosis
us
Gilman2,7, for the Cysticercosis Working Group in Peru
2 Alternate corresponding author. Javier A. Bustos, MD, MPH. Center for Global Health,
3288589, Fax +511 3284038, email
[email protected]
keypoints
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Universidad Peruana Cayetano Heredia, H. Delgado 430, SMP, Lima 31, Perú. Tel +511
cysticercosis cysts were compared. Cysticidal efficacy was higher in the combined therapy
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group both in terms of proportions of cysts resolved and patients with complete cyst clearance.
ABSTRACT
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Background. The efficacy of current antiparasitic treatment for cerebral Taenia solium cysticercosis with either albendazole or praziquantel is sub-optimal. A recent study
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demonstrated that combining these two antiparasitic drugs improves antiparasitic efficacy. We present here the parasiticidal efficacy data obtained during a previous Phase II pharmacokinetic study that compared combined albendazole plus praziquantel with albendazole alone.
Methods. Randomized, double-blinded, placebo-controlled Phase II evaluation of the
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pharmacokinetics of albendazole (15 mg/k/d, for 10 days) and praziquantel (50 mg/k/d, for 10 days) in intraparenchymal brain cysticercosis. Patients received the usual concomitant
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medications including an antiepileptic drug (phenytoin or carbamazepine), dexamethasone, and ranitidine. Randomization was stratified by antiepileptic drug. Patients had safety laboratory evaluations at days 4, 7, and 11, as well as a 6-months MRI to assess parasiticidal efficacy.
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us
The efficacy of albendazole alone or in combination with praziquantel to destroy cerebral
Results. Thirty-two patients were included, 16 in each arm. All of them completed antiparasitic treatment and had a follow up brain MRI performed. Cysticidal efficacy was strikingly higher in the combined albendazole plus praziquantel group than in the albendazole alone group
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(proportion of cysts resolved 78/82, 95% versus 23/77, 30%, RR 3.18, 95% CI 2.08 – 4.88,
p
