Randomized comparison of low-dose versus standard-dose praziquantel therapy in treatment of urinary tract morbidity due to Schistosoma haema tobium infection.
At present, anthelmintic therapy with praziquantel at a dose of 40 mg/kg of body weight is the recommended treatment for control of urinary tract morbidity caused by Schistosoma haematobium. Although this standard regimen is effective, drug cost may represent a significant barrier to implementation of large-scale schistosomiasis control programs in developing areas. Previous comparison trials have established that low-dose (20-30 mg/kg) praziquantel regimens can effectively suppress the intensity of S. haematobium infection in endemic settings. However, the efficacy of these low-dose regimens in controlling infection-related morbidity has not been determined in a randomized field trial. The present random allocation study examined the relative efficacy of a 20 mg/kg dose versus a 40 mg/kg dose of praziquantel in control of hematuria and bladder and renal abnormalities associated with S. haematobium infection in an endemic area of Coast Province, Kenya. After a nine-month observation period, the results indicated an advantage to the standard 40 mg/kg praziquantel dose in terms of reduction of infection prevalence and hematuria after therapy (P < 0.01 and P < 0.005, respectively). However, the two treatment groups were equally effective in reducing structural urinary tract morbidity detected on ultrasound examination. We conclude that in certain settings, a 20 mg/kg dose of praziquantel may be sufficient in providing control of morbidity due to urinary schistosomiasis in population-based treatment programs.
King
Charles H
CH
Department of Medicine, Case Western Reserve University and University Hospitals of Cleveland, Ohio 44106-4983, USA. chk@po.cwru.edu
Muchiri
Eric M
EM
Mungai
Peter
P
Ouma
John H
JH
Kadzo
Hilda
H
Magak
Philip
P
Koech
Davy K
DK
D000293:Adolescent; D000328:Adult; D000818:Animals; D000871:Anthelmintics / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005843:Geography; D006417:Hematuria / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007630:Kenya; D008297:Male; D009017:Morbidity; D010270:Parasite Egg Count; D011223:Praziquantel / Q000009:adverse effects / Q000627:therapeutic use*; D012424:Rural Population; D012548:Schistosoma haematobium; D012553:Schistosomiasis haematobia / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014570:Urologic Diseases / Q000453:epidemiology / Q000469:parasitology* / Q000517:prevention & control
D000871:Anthelmintics; D011223:Praziquantel