title: Dynamics of Schistosoma haematobium egg output and associated infection parameters following treatment with praziquantel in school-aged children.
abstract: BACKGROUND
  Praziquantel is the drug of choice in preventive chemotherapy targeting schistosomiasis. Increasing large-scale administration of praziquantel requires monitoring of drug efficacy to detect early signs of development of resistance. Standard protocols for drug efficacy monitoring are necessary. Here, we determined the optimal time point for praziquantel efficacy assessment against Schistosoma haematobium and studied the dynamics of infection parameters following treatment.
  
  
  METHODS
  Ninety school-aged children from south Côte d'Ivoire with a parasitologically confirmed S. haematobium infection were treated with a single oral dose of praziquantel (40 mg/kg) and followed up for 62 days post-treatment. Urine samples were collected on 23 schooldays during this period and were subjected to visual examination (macrohaematuria), urine filtration and microscopy (S. haematobium eggs) and reagent strip testing (microhaematuria, proteinuria and leukocyturia).
  
  
  RESULTS
  Observed cure and egg reduction rates were highly dependent on the time point post-treatment. Egg reduction rates were high (>97%) in weeks 3-9 post-treatment. Cure rates were highest in weeks 6 (92.9%) and 9 (95.0%) post-treatment. The prevalence of infection-associated parameters decreased after treatment, reaching a minimum of 2.4% in weeks 5 (proteinuria) and 7 (leukocyturia) post-treatment, and 16.3% at the end of week 8 (microhaematuria). Macrohaematuria disappeared between weeks 3 and 6 post-treatment.
  
  
  CONCLUSIONS
  For monitoring praziquantel efficacy against S. haematobium, we recommend that the cure rate is assessed at week 6 post-treatment. The egg reduction rate can be evaluated earlier, from day 14 post-treatment onwards. Reagent strips are a useful additional tool for evaluating treatment outcomes in areas with high endemicity, preferably at weeks 5 and 6 post-treatment. The delayed decrease of microhaematuria confirms that lesions in the urinary tract persist longer than egg excretion post-treatment.
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Katarina
authors.initials: K
authors.lastname: Stete
authors.forename: Stefanie J
authors.initials: SJ
authors.lastname: Krauth
authors.forename: Jean T
authors.initials: JT
authors.lastname: Coulibaly
authors.forename: Stefanie
authors.initials: S
authors.lastname: Knopp
authors.forename: Jan
authors.initials: J
authors.lastname: Hattendorf
authors.forename: Ivan
authors.initials: I
authors.lastname: Müller
authors.forename: Laurent K
authors.initials: LK
authors.lastname: Lohourignon
authors.forename: Winfried V
authors.initials: WV
authors.lastname: Kern
authors.forename: Eliézer K
authors.initials: EK
authors.lastname: N'goran
authors.forename: Jürg
authors.initials: J
authors.lastname: Utzinger
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage*; D002648:Child; D007560:Cote d'Ivoire / Q000453:epidemiology; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D008297:Male; D010270:Parasite Egg Count; D011223:Praziquantel / Q000008:administration & dosage*; D012548:Schistosoma haematobium / Q000187:drug effects / Q000502:physiology*; D012553:Schistosomiasis haematobia / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology; D016896:Treatment Outcome
chemical_list: D000871:Anthelmintics; D011223:Praziquantel