Drugs five years later: praziquantel.
OBJECTIVE
To identify advances in knowledge of the pharmacokinetics, mechanism of action, clinical use, and side effects of the antihelminthic drug praziquantel in the 5 years since its introduction in the United States.


METHODS
Studies reported from 1983 to July 1988 were identified by computer searches of MEDLINE and TOXLINE, and review of textbooks and review articles.


METHODS
Of 57 articles originally identified, 39 were selected by two readers.


METHODS
Study quality and significance were independently assessed by each reader.


RESULTS
The pharmacokinetics and clinical efficacy of praziquantel have been well documented. Yet, despite extensive in vivo and in vitro laboratory studies, the drug's mechanism of action in killing parasites is unknown. Although the efficacy of praziquantel was first established for treating schistosomiasis, in the last 5 years its clinical use has been expanded to the treatment of intestinal, tissue, and lung flukes, and intestinal and tissue cestode infections, including neurocysticercosis. The introduction of praziquantel was a significant advance in antihelminthic therapy, in that it was effective therapy for several parasites that had been previously considered untreatable. Availability of a safe, effective broad-spectrum oral antihelminthic agent consolidated the central role of chemotherapy in population-based control of many trematode and cestode parasites. Randomized trials have shown, however, that older, cheaper agents may be more cost-effective in controlling Schistosoma mansoni and Schistosoma haematobium in some endemic areas.


CONCLUSIONS
Although praziquantel is the treatment of choice for most human trematode and cestode infections, cost factors have limited its use in developing countries.
King
C H
CH
Case Western Reserve University and University Hospitals, Cleveland, Ohio.
Mahmoud
A A
AA
D000818:Animals; D001927:Brain Diseases / Q000188:drug therapy / Q000378:metabolism; D003365:Costs and Cost Analysis; D003551:Cysticercosis / Q000188:drug therapy / Q000378:metabolism; D004443:Echinococcosis / Q000188:drug therapy; D006801:Humans; D011223:Praziquantel / Q000378:metabolism / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D012547:Schistosoma / Q000187:drug effects; D012552:Schistosomiasis / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D013997:Time Factors; D014481:United States
D011223:Praziquantel