Abstract
BackgroundPraziquantel has been used as first-line drug for chemotherapy of schistosomiasis since 1984. Besides praziquantel, artemether and artesunate have also been used for the control of this infectious disease since late 1990s. In this article, we conducted a systematic review and meta-analysis to evaluate the antischistosomal efficacy of different medication strategies including monotherapy or combination therapies of these drugs.ResultsA number of 52 trials from 38 articles published in peer-reviewed journals before July 2011 were selected for analysis after searching the following literature databases: the Cochrane Library, PubMed/Medline, ISI Web of Science, Chinese Biomedicine Literature Database, and China National Knowledge Infrastructure. Our meta-analyses showed that a dosage of 30-60 mg/kg praziquantel compared with placebo produced a protection rate of about 76% (95% CI: 67%-83%) for treating human schistosomiasis, which varied from 70% to 76% with no significant differences among the subspecies S. haematobium, S. japonicum or S. mansoni. Protection rates were higher when praziquantel doses were elevated, as concluded from the nRCTs results: the protection rate of praziquantel at 40 mg/kg was 52% (95% CI: 49%-55%), and it increased to 91% (95% CI: 88%-92%) when the dosages were elevated to 60/80/100 mg/kg divided two or more doses. Multiple doses of artemether or artesunate over 1- or 2-week intervals resulted in protection rates of 65% to 97% for preventing schistosomiasis, and increased doses and shorter medication intervals improved their efficacies. Praziquantel and artemisinin derivatives (artemether or artesunate) in combination resulted in a higher protection rate of 84% (95% CI: 64%-91%) than praziquantel monotherapy for treatment. praziquantel and artesunate in combination had a great protection rate of 96% (95% CI: 78%-99%) for preventing schistosomes infection.ConclusionsAccording to the results, praziquantel remains effective in schistosomiasis treatment, and multiple doses would improve its efficacy; meanwhile, praziquantel is also a good drug for preventing acute schistosomiasis morbidity. It's better to use multiple doses of artemether or artesunate with 1- or 2-week intervals for prevention against schistosome infection. Praziquantel and artemether or artesunate in combination perform better in treatment than praziquantel monotherapy, and they are especially suitable for treating the patients with repeated exposure to infected water.
Highlights
Praziquantel has been used as first-line drug for chemotherapy of schistosomiasis since 1984
PZQ dosages applied ranged from a single oral dose of 30-60 mg/kg or divided (2-3) dosages in randomized controlled trials (RCTs)-designed studies, and only one trial reported about participants who had received a single oral dose of PZQ at 20 mg/kg [35]
In another study with PZQ and AS in combination to treat schistosomiasis japonica by soldiers participating in fighting against floods, participants of the experimental group received 1200 mg PZQ once divided into two doses and AS 300 mg once for every 7 days, participants in the control group received nothing [61]
Summary
Praziquantel has been used as first-line drug for chemotherapy of schistosomiasis since 1984. Artemether and artesunate have been used for the control of this infectious disease since late 1990s. Schistosomiasis, an infectious disease caused by parasitic trematodes (schistosomes) dwelling in the host’s mesenteric portal system, is a great public health problem in tropical and subtropical regions. Schistosomiasis control remains a challenge in endemic regions [4,5,6,7]. There are five schistosome species parasitizing in humans: Schistosoma japonicum, S. mansoni, S. haematobium, S. mekongi, and S. intercalatum. S. japonicum is transmitted by the amphibian snail Oncomelania and causes intestinal and hepatosplenic schistosomiasis in the People’s Republic of China, Philippines, and Indonesia; S. mansoni, transmitted by Biomphalaria snails, causes intestinal and hepatic schistosomiasis in Africa, the Arabian peninsula, and South America; S. haematobium, transmitted by Bulinus snails, causes urinary schistosomiasis in Africa and the Arabian peninsula. S. mekongi and S. intercalatum are only of local importance [1,2,3,8,9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
