Parasitology

SECTION 5 TOWARDS FUTURE USE OF PRAZIQUANTEL

Treatment of urinary schistosomiasis: methodological issues and research needs identified through a Cochrane systematic review

A. DANSO-APPIAHa1a2 c1, P. GARNERa1, P. L. OLLIAROa3 and J. UTZINGERa4

a1 International Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK

a2 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands

a3 UNICEF/UNDP/World Bank/WHO Special Programme on Research and Training in Tropical Diseases, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland

a4 Department of Public Health and Epidemiology, Swiss Tropical Institute, P.O. Box, CH-4002 Basel, Switzerland

SUMMARY

Guidelines recommend praziquantel (PZQ) for the treatment and control of schistosomiasis, with no real alternative. Metrifonate was still widely used against Schistosoma haematobium in the 1990s, and then withdrawn. Experimental studies and clinical trials suggest that artemisinin compounds are active against S. haematobium. In a Cochrane systematic review assessing the efficacy and safety of drugs for treating urinary schistosomiasis, 24 randomized controlled trials (n=6315 individuals) met our inclusion criteria. These trials compared a variety of single agent and combination regimens with PZQ, metrifonate or artemisinin derivatives. The review confirmed that both the standard recommended doses of PZQ (single 40 mg/kg oral dose) and metrifonate (3×7·5–10 mg/kg oral doses administered fortnightly) are efficacious and safe in treating urinary schistosomiasis, but there is no study comparing these two regimens head-to-head. There is currently not enough evidence to evaluate artemisinin compounds. Most of the studies included in the Cochrane systematic review were insufficiently powered, lacked standardization in assessing and reporting outcomes, and had a number of methodological limitations. In this paper we discuss the implications of these findings with respect to public health and research methodology and propose priority research needs.

(Received October 29 2008)

(Revised January 23 2009)

(Accepted January 27 2009)

(Online publication June 03 2009)

Correspondence:

c1 Corresponding author: Anthony Danso-Appiah, International Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. E-mail: tdappiah@yahoo.co.uk

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