Review Anthelminthic treatment: An adjuvant therapeutic strategy against Echinococcus granulosus M. Stamatakos a, ⁎, C. Sargedi b , Ch. Stefanaki a , C. Safioleas a , I. Matthaiopoulou c , M. Safioleas a a 2nd Propaedeutic Department of Surgery, Medical School, University of Athens, Laiko General Hospital, Athens, Greece b Department of Internal medicine, Ystad hospital, Sweden c Department of Pediatrics, General Hospital of Tripoli, Greece abstract article info Article history: Received 1 September 2008 Received in revised form 30 December 2008 Accepted 7 January 2009 Available online 20 January 2009 Keywords: Echinococciasis Benzoimidazole carbonates Drug dosage Efficacy Recurrence The main goal of the paper is to clarify anthelminthic treatment as an alternative hydatic cyst therapy, its indications and contraindications. Chemotherapy constitutes a non-invasive treatment and is less limited by the patient's status than surgery or PAIR. Many investigators have employed benzoimidazole carbonates for the management of human hydatid disease. Both, albendazole and mebendazole have, a favourable effect in patients suffering from multiorgan and multicystic disease, in inoperable primary liver or lung echinococcosis, and they can also prevent secondary echinococcosis. Chemotherapy is contraindicated for large cysts that are at risk to rupture and for inactive or calcified cysts. The main adverse events are related to changes in liver enzyme levels. The best efficacy is observed with liver, lung, and peritoneal cysts. Certain various factors influence the therapeutic results of medical treatment. The vast majority of the recurring cysts show good susceptibility to re-treatment. © 2009 Elsevier Ireland Ltd. All rights reserved. Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 2. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 3. Reasons for the development of medical treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 4. Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 5. Mode of action. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 6. Pharmacologic properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 7. Recommended drug dosage and treatment duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 8. Adverse reactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 9. Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 10. Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 11. Efficacy-therapeutic results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 12. Recurrence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 13. Other drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 14. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 1. Introduction Cystic Echinococcosis has for many years been a manifestation of parasitic infection, which can potentially lead even to death. The etiologic factor is a small tapeworm that is transmitted incidentally to humans, and is classified to the following types: E. granulosus, E. multilocularis, E. vogeli, E. oligarithrosis [1] and last but not least E. shiquicus [2,3]. Human Cystic Echinococcosis is generally caused by Echinococcus granulosus larvae. Humans are intermediate hosts that become infected following ingestion of contaminated food and/or water [4]. A primary cystic echinococcosis occurs when an organ traps the larvae following intestinal absorption. Arrest occurs in the capillary beds of the liver or lung in nearly 90% of the cases. Cystic echinococcosis in organs other than the liver or the lungs are usually part of generalized Parasitology International 58 (2009) 115–120 ⁎ Correspoding author. 5, Valaoritou, Ano Glyfada, 16674 Athens, Greece. E-mail address: stamatakosmih@yahoo.gr (M. Stamatakos). 1383-5769/$ – see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.parint.2009.01.002 Contents lists available at ScienceDirect Parasitology International journal homepage: www.elsevier.com/locate/parint