Echinococcosis: Drug Therapy

Therapeutic target

  • Cyst inactivation

Therapy recommendation

  • Alveolar echinococcosis (AE).
    • If surgical resection is not possible: lifelong therapy with with the benzimidazoles albendazole or mebendazole (anthelmintics/drugs against worm diseases) Close follow-up; if necessary, later surgical curative resection (surgical removal aimed at curing the patient) if the response to drug therapy is good.
  • Cystic Echinococcosis (CE).
    • Primary hepatic cysts
      • CL, CE 4, CE 5: observe and monitor (Wait and Watch).
      • CE 1,2,3: Invasive imaging procedures (percutaneous aspiration, scolicide, instillation, re-aspiration = PAIR) or surgical resection under albendazole coverage (see below “Surgical Therapy“).
    • Secondary echinococcosis (spread of daughter cysts outside the mother cyst): therapy with albendazole (benzimidazole).
  • See also under “Further therapy”.

Legend

  • Wg. CL, CE1-5 see under classification.

Active ingredients (main indication)

Benzimidazoles (anthelmintic).

  • Mode of action: vermicidal
  • Dosage information:
    • In alveolar echinococcosis lifelong; therapeutic serum levels must be adjusted and monitored in the process.
    • For cystic echinococcosis perioperatively for up to four weeks/three months.
  • Side effects: Headache, dizziness, gastrointestinal (nausea, abdominal pain), liver enzymes ↑ (albendazole hepatitis), fever, hair loss; bone marrow suppression.
  • Initially 1, then 3-monthly checks of liver enzymes and blood counts!