Randomised controlled trial of efficacy of albendazole in intra-abdominal hydatid disease

• Published in: The Lancet (British edition) Vol. 342; no. 8882; pp. 1269 - 1272
• Main Authors: Gil-Grande, L.A., Sánchez-Ruano, J.J., García-Hoz, F., Bárcena, R., Rodriguez-Caabeiro, F., Brasa, C., Casado, N., Prieto, J.G., Alvarez, A.I., Aguilar, L., Dal-Ré, R.
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 20.11.1993; Lancet; Elsevier Limited
• Subjects: Adult; Albendazole; Albendazole - adverse effects; Albendazole - pharmacology; Albendazole - therapeutic use; Animals; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiparasitic agents; Biological and medical sciences; Combined Modality Therapy; Cysts; Disease; Disease control; Disintegration; Drugs; Echinococcosis, Hepatic - diagnostic imaging; Echinococcosis, Hepatic - drug therapy; Echinococcosis, Hepatic - surgery; Echinococcus - drug effects; Echinococcus - isolation & purification; Effectiveness; Evidence-based medicine; Female; Humans; Hydatid disease; Liver; Liver - diagnostic imaging; Liver - parasitology; Liver - surgery; Liver diseases; Male; Medical research; Medical sciences; Medical treatment; Middle Aged; Parasites; Patients; Pharmacology. Drug treatments; Prospective Studies; Randomization; Surgery; Treatment Outcome; Ultrasonography; Ultrastructure; Viability; Cestod disease; Human; Infection; Chemotherapy; Treatment; Parasiticid; Parasitosis; Hydatid cyst; Helminthiasis; Echinococciasis; Abdomen; Result
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/0140-6736(93)92361-V

The efficacy of albendazole in hydatid disease is still unclear, because there has been no study that assessed the status of the parasite after treatment. The significance of albendazole- induced echographic changes in the cyst therefore cannot be judged. We did a prospective, controlled, randomised, open study of albendazole in patients with liver hydatid disease, and assessed parasite viability after treatment. 18 patients received no albendazole treatment (controls), 18 received albendazole (10 mg/kg daily) for 1 month (group A), and 19 received the drug for about 3 months (group B). Echography was done before and during treatment; all patients underwent surgery on completion. Parasite (protoscolex viability and development of cysts in mice) and ultrastructure studies were done for all cysts removed. 8 (50%) of cysts in the control group, 13 (72%) in group A, and 16 (94%) in group B were non-viable (p=0·015). Protoscolex and cyst viability were significantly (p=0·039 and p=0·018, respectively) lower in treated patients than in controls. Treatment was also significantly associated with total cyst membrane disintegration. 68% of cysts treated for 3 months showed echographic changes, and only 1 of 20 cysts showing echographic changes during treatment was judged viable. The efficacy of albendazole at a dose of 10 mg/kg daily for 3 months suggests that it is a suitable alternative to surgery in uncomplicated hydatid liver disease, as initial treatment.