Albendazolesulphoxide concentrations in plasma and hydatid cyst and prediction of parasitological and clinical outcomes in patients with liver hydatidosis caused by Echinococcus granulosus.
OBJECTIVE
To investigate the relationship between plasma and cyst concentrations of albendazolesulphoxide (ASO) and their effects on parasitological findings and disease recurrence in patients with liver hydatidosis.


METHODS
The study was conducted at the University Hospital for Infectious Diseases Dr. Fran Mihaljević, Zagreb, Croatia, between August 2006 and January 2011. Consecutive patients (N=48, age 6-77 years) were treated with albendazole (3×5 mg/kg/d) over 28 days before surgical cyst removal (n=34) or percutaneous evacuation (PAIR) (n=14). Plasma ASO was determined on days 10 and 28 of treatment and cyst concentrations at surgery/PAIR.


RESULTS
Disease recurred in 3 surgically treated patients. Variability of ASO concentrations was substantial. Plasma concentrations on day 10 were higher than on day 28 (geometric means ratio [GMR] 2.00; 95%CI 1.38-2.91, P<0.001) and higher than cyst concentrations at the time of treatment (GMR=1.58, 1.01-2.34, P=0.045). Higher cyst (but not plasma) concentrations were independently associated with lower odds of protoscolex motility (OR=0.23, 0.01-0.70, P<0.001) and higher odds of protoscolex destruction (OR=1.17, 1.04-1.46, P<0.001). With adjustment for age and protoscolex motility, higher day 10 plasma concentrations (but not cyst concentrations) were associated with lower odds of disease recurrence (OR=0.49, 0.09-0.97, P=0.035). Plasma concentrations did not predict cyst concentrations.


CONCLUSIONS
Viability of protoscolices progressively decreased with increasing ASO concentrations in the cyst. Data strongly suggested that higher plasma concentrations reduced the risk of disease recurrence.
Tomislava Skuhala, University Hospital for Infectious Diseases Fran Mihaljevic, Mirogojska 8, 10000 Zagreb, Croatia, tomislava_skuhala@yahoo.com.
Tomislava
T
Skuhala
Vladimir
V
Trkulja
Mislav
M
Runje
Dalibor
D
Vukelic
Bosko
B
Desnica
D000293:Adolescent; D000328:Adult; D000368:Aged; D015766:Albendazole / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D000818:Animals; D000871:Anthelmintics / Q000493:pharmacokinetics*; D000909:Antibodies, Helminth / Q000097:blood; D000947:Antigens, Helminth / Q000276:immunology; D001682:Biological Availability; D002648:Child; D004444:Echinococcosis, Hepatic / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism* / Q000601:surgery; D048209:Echinococcus granulosus / Q000187:drug effects* / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome; D055815:Young Adult
D000871:Anthelmintics; D000909:Antibodies, Helminth; D000947:Antigens, Helminth; D015766:Albendazole; C027186:albendazole sulfoxide