title: Safety and efficacy of praziquantel syrup (Epiquantel®) against Schistosoma haematobium and Schistosoma mansoni in preschool-aged children in Niger.
abstract: Given the characteristic age-prevalence curve of Schistosoma infection, preventive chemotherapy with praziquantel is primarily targeted at school-aged children, whilst, in highly endemic areas, other high-risk groups might be included for regular treatment. Nevertheless, schistosomiasis can affect children well before they reach school-age, but this population group is usually excluded from preventive chemotherapy. We assessed the safety and efficacy of praziquantel syrup (Epiquantel®) in preschool-aged children in three villages of Niger. Children aged ≤72 months provided multiple urine and stool samples that were microscopically examined using standard protocols. Schistosoma-positive children were treated with praziquantel syrup at a dose of 40 mg/kg after a meal of millet porridge. Children remained under medical supervision for 4h and adverse events were recorded. Additionally, a questionnaire was administrated to the mothers/guardians 24h post-treatment for further probing of adverse events. Treatment efficacy was evaluated 3 and 6 weeks post-treatment using multiple stool and urine samples. A third of the 243 treated children reported adverse events within 4h, whilst a further 6.2% reported adverse events upon probing 24h post-treatment. Abdominal pain, bloody diarrhoea and sleepiness were the most common adverse events, but these were transient and self-limiting. Praziquantel syrup showed moderate-to-high efficacy against Schistosoma haematobium with egg reduction rates of 69.4% and 71.2% 3 and 6 weeks post-treatment and cure rates of 85.7% (95% confidence interval (CI) 79.7-90.5%) and 94.9% (95% CI 90.5-97.6%), respectively. Considerably lower cure and egg reduction rates were observed against Schistosoma mansoni (e.g. cure rate at 6-week post-treatment follow-up was only 50.6% (95% CI 39.9-61.2%). Concluding, praziquantel syrup is well tolerated in preschool-aged children with moderate-to-high efficacy against S. haematobium, but considerably lower efficacy against S. mansoni in Niger. A larger study is warranted to investigate the observed differences in species-specific susceptibilities and to assess operational issues and community-effectiveness.
authors.affiliation: Réseau International Schistosomoses, Environnement, Aménagement et Lutte (RISEAL-Niger), 1448, Bd de l'Indépendance, B.P. 13724, Niamey, Niger; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland. Electronic address: garbamadou@yahoo.fr.
authors.forename: Amadou
authors.initials: A
authors.lastname: Garba
authors.forename: Mariama S
authors.initials: MS
authors.lastname: Lamine
authors.forename: Ali
authors.initials: A
authors.lastname: Djibo
authors.forename: Almoustapha
authors.initials: A
authors.lastname: Tahirou
authors.forename: Mahamadou Aboubacar
authors.initials: MA
authors.lastname: Aouami
authors.forename: Aichatou
authors.initials: A
authors.lastname: Alfari
authors.forename: Anna E
authors.initials: AE
authors.lastname: Phillips
authors.forename: Alan
authors.initials: A
authors.lastname: Fenwick
authors.forename: Jürg
authors.initials: J
authors.lastname: Utzinger
mesh_terms: D000284:Administration, Oral; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage* / Q000009:adverse effects*; D018890:Chemoprevention / Q000009:adverse effects* / Q000379:methods*; D002675:Child, Preschool; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000473:pathology; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009548:Niger; D011223:Praziquantel / Q000008:administration & dosage* / Q000009:adverse effects*; D012548:Schistosoma haematobium / Q000302:isolation & purification*; D012550:Schistosoma mansoni / Q000302:isolation & purification*; D012553:Schistosomiasis haematobia / Q000188:drug therapy* / Q000469:parasitology; D012555:Schistosomiasis mansoni / Q000188:drug therapy* / Q000469:parasitology; D016896:Treatment Outcome; D014556:Urine / Q000469:parasitology
chemical_list: D000871:Anthelmintics; D011223:Praziquantel