Drugs for treating Schistosoma mansoni infection

Drugs for treating Schistosoma mansoni infection

Anthony Danso-Appiah1,*, Piero L Olliaro2, Sarah Donegan1, David Sinclair1, Jürg Utzinger3,4

Liverpool School of Tropical Medicine, International Health Group, Liverpool, UK
World Health Organization, UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland
Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Basel, Switzerland
University of Basel, Basel, Switzerland

Danso-Appiah A, Olliaro PL, Donegan S, Sinclair D, Utzinger J. Drugs for treating Schistosoma mansoni infection. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD000528.

To read the full review please follow this link: DOI: 10.1002/14651858.CD000528.pub2. 

Schistosoma mansoni is a parasitic worm common in Africa, the Middle East and parts of South America. The worm larvae live in ponds and lakes contaminated by faeces, and can penetrate a persons’ skin when they swim or bathe. Inside the host, the larvae grow into adult worms; these produce eggs, which are excreted in the faeces. Eggs rather than worms cause disease. Long-term infection can cause bloody diarrhoea, abdominal pains, and enlargement of the liver and spleen.

In this review, researchers in the Cochrane Collaboration evaluated drug treatments for people infected with Schistosoma mansoni. After searching for all relevant studies, they found 52 trials, including 10,269 people, conducted in Africa, Brazil and the Middle East. Most trials report on whether or not the treatment stops eggs excretion; three reported the persons recovery from symptoms.

The results show that a single dose of praziquantel (40 mg/kg), as recommended by the World Health Organization, is an effective treatment for Schistosoma mansoni infection. Lower doses may be less effective, and higher doses probably have no additional benefit.

Oxamniquine (40 mg/kg), though now rarely used, is also effective. Again, lower doses may be less effective and no advantage has been demonstrated with higher doses.

Only one study directly compared praziquantel 40 mg/kg with oxamniquine 40 mg/kg, and based on this limited evidence, we are uncertain which intervention is more effective. Adverse events were not well reported for either drug, but were mostly described as minor and transient.

In children aged less than 5 years, there is limited evidence that these doses may be less effective, and further research will help optimise the dose for this age-group.