eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Echinococcosis: Treatment & Medication

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Jan 22, 2009

Treatment

Medical Care

  • Preoperative and postoperative albendazole therapy may be beneficial in patients with echinococcosis. As an alternative to surgical management, a randomized controlled study of albendazole in uncomplicated hepatic hydatid disease in adults concluded that 10 mg/kg/d for 3 months without rest periods was effective and could be tried before surgical intervention. In children, the dose is 15 mg/kg/d for 28 days and is repeated, as necessary.
  • The World Health Organization (WHO) recommends postoperative chemotherapy for 2.5 years after radical surgery for alveolar hydatid disease.
  • Inoperable cases can be treated with albendazole or mebendazole. An overall response rate of 55-79% has been documented, with cure in 29% of cases. Albendazole is the drug of choice because of its greater absorption from the GI tract with higher plasma levels. Mebendazole is poorly absorbed and must be taken at higher doses for several months for a therapeutic effect. Albendazole is administered in 3 or more cycles of 400-800 mg twice daily for 4 weeks (adult dose), followed by a 2-week period of rest. If response to 3 cycles is not evident, subsequent courses are unlikely to be beneficial. Response to therapy is best monitored by serial imaging studies.

Surgical Care

  • Surgery is the treatment of choice for most cases of cystic echinococcosis and is usually successful. Alveolar echinococcosis is less amenable to surgery and medical therapy may be useful.
    • Liver surgery options include the following:
      • Partial hepatic resection
      • Pericystectomy
      • Cystectomy
    • In 20% of cases, disease recurs despite surgery.
  • Some clinicians have inactivated the fertile cyst with formalin or 30% saline in combination with resection. Sclerosing cholangitis may occur as a complication of this procedure.
  • An alternative to surgery is the PAIR method (ie, puncture the cyst, aspirate fluid, introduce a protoscolicidal agent, then reaspirate), which requires ultrasonographic guidance.2 Extreme care is essential to prevent spilling hydatid fluid into a body cavity because this may lead to anaphylactic shock. Albendazole therapy may be combined with PAIR from 10 days before to 30 days after the procedure. PAIR is a promising technique, although large-scale clinical trails have not yet been conducted.
  • Some severe cases of alveolar hydatid disease have led to liver transplantation.

Consultations

  • Recommended consultations for echinococcosis include surgeons and infectious diseases specialists with experience in diagnosis and treatment of the disease.

Diet

  • To prevent repeat infections, instruct patients to wash fruits and vegetables thoroughly and to consume only well-cooked meats.

Medication

Albendazole is considered the drug of choice in echinococcosis. Praziquantel should not be used because the drug may aid alveolar hydatid growth.

Anthelmintics

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents administered in relatively small doses.


Albendazole (Albenza)

Decreases ATP production in tapeworms, causing energy depletion, immobilization, and death. To avoid inflammatory response in CNS, patient must be started on anticonvulsants and high-dose glucocorticoids. Administer with food to increase absorption.

Adult

<60 kg: 15 mg/kg/d PO divided q12h for 1-3 mo; not to exceed 800 mg/d
>60 kg: 400 mg PO bid for 1-3 mo

Pediatric

15 mg/kg/d PO divided q12h for 28 d; not to exceed 800 mg/d; may repeat dosage cycle as needed for 1-3 mo

Coadministration with carbamazepine may decrease efficacy; dexamethasone, cimetidine, ritonavir, and praziquantel may increase toxicity

Documented hypersensitivity; hepatic disease

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Discontinue use if liver function test results increase significantly (resume when levels decrease to pretest values); treat in liver damage with reduced doses, if at all; use only under constant medical supervision and regular monitoring of serum transaminase concentrations and of leucocyte, RBC, and platelet counts (rare cases of bone marrow damage have been reported)

More on Echinococcosis

Overview: Echinococcosis
Differential Diagnoses & Workup: Echinococcosis
Treatment & Medication: Echinococcosis
Follow-up: Echinococcosis
Multimedia: Echinococcosis
References
Further Reading
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References

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Further Reading

See Image 25 and Image 60 at the McGill Faculty of Medicine Web site and The Gorgas Courses in Clinical Tropical Medicine for interesting images and cases.

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Keywords

echinococcosis, abdominal pain, alveolar hydatid echinococcosis, anaphylaxis, asthma, biliary obstruction, cystic echinococcosis, Echinococcus infection, Echinococcus granulosus, E granulosus, Echinococcus multilocularis, E multilocularis, Echinococcus vogeli, E vogeli, hydatid disease, hydatidosis, polycystic echinococcosis, urticaria

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Medical Editor

Michael D Nissen, MBBS, BMedSc, FRACP, FRCPA, Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital
Michael D Nissen, MBBS, BMedSc, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University
Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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