title: Cysticidal Efficacy of Combined Treatment With Praziquantel and Albendazole for Parenchymal Brain Cysticercosis.
abstract: The efficacy of current antiparasitic treatment for cerebral Taenia solium cysticercosis with either albendazole (ABZ) or praziquantel (PZQ) is suboptimal. A recent study demonstrated that combining these 2 antiparasitic drugs improves antiparasitic efficacy. We present here the parasiticidal efficacy data obtained during a previous phase II pharmacokinetic study that compared combined ABZ plus PZQ with ABZ alone.
  
  
  
  The study was a randomized, double-blinded, placebo-controlled phase II evaluation of the pharmacokinetics of ABZ (15 mg/k/d, for 10 days) and PZQ (50 mg/k/d, for 10 days) in intraparenchymal brain cysticercosis. Patients received the usual concomitant medications, including an antiepileptic drug (phenytoin or carbamazepine), dexamethasone, and ranitidine. Randomization was stratified by antiepileptic drug. Patients underwent safety laboratory evaluations at days 4, 7, and 11, as well as magnetic resonance (MR) imaging at 6 months to assess parasiticidal efficacy.
  
  
  
  Thirty-two patients were included, 16 in each arm. All of them completed antiparasitic treatment and underwent follow-up brain MR imaging. Cysticidal efficacy was strikingly higher in the combined ABZ-plus-PZQ group than in the ABZ-alone group (proportion of cysts resolved, 78 of 82 [95%] vs 23 of 77 [30%] [relative risk {RR}, 3.18; 95% confidence interval {CI}, 2.08-4.88; P < .001]; patients with complete cyst clearance, 12 of 16 [75%] vs 4 of 16 [25%] [RR, 3.00; 95% CI, 1.23-7.34; P = .005]).
  
  
  
  The combination of ABZ plus PZQ is more effective in destroying viable brain cysticercosis cysts than ABZ alone.
  
  
  
  NCT00441285.
authors.affiliation: Cysticercosis Unit, Department of Transmissible Diseases, Instituto Nacional de Ciencias Neurologicas Department of Microbiology, School of Sciences Center for Global Health.
authors.forename: Hector H
authors.initials: HH
authors.lastname: Garcia
authors.affiliation: School of Public Health, Universidad Peruana Cayetano Heredia, San Martín de Porres Department of Parasitology, US Naval Medical Research Unit No. 6.
authors.forename: Andres G
authors.initials: AG
authors.lastname: Lescano
authors.affiliation: Cysticercosis Unit, Department of Transmissible Diseases, Instituto Nacional de Ciencias Neurologicas.
authors.forename: Isidro
authors.initials: I
authors.lastname: Gonzales
authors.affiliation: Center for Global Health.
authors.forename: Javier A
authors.initials: JA
authors.lastname: Bustos
authors.affiliation: Hospital Nacional Alberto Sabogal, ESSALUD, Callao, Peru.
authors.forename: E Javier
authors.initials: EJ
authors.lastname: Pretell
authors.affiliation: Tropical Projects, Hitchin, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Horton
authors.affiliation: Cysticercosis Unit, Department of Transmissible Diseases, Instituto Nacional de Ciencias Neurologicas.
authors.forename: Herbert
authors.initials: H
authors.lastname: Saavedra
authors.affiliation: School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Salamanca de Monterrico, Ate, Lima.
authors.forename: Armando E
authors.initials: AE
authors.lastname: Gonzalez
authors.affiliation: Department of Microbiology, School of Sciences Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
mesh_terms: D000293:Adolescent; D000328:Adult; D015766:Albendazole / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D000923:Anticestodal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001927:Brain Diseases / Q000188:drug therapy* / Q000469:parasitology; D005260:Female; D006801:Humans; D008297:Male; D020019:Neurocysticercosis / Q000188:drug therapy* / Q000469:parasitology; D011223:Praziquantel / Q000494:pharmacology / Q000627:therapeutic use*; D041201:Taenia solium / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000923:Anticestodal Agents; D011223:Praziquantel; D015766:Albendazole
keywords: Peru; Taenia solium; albendazole; neurocysticercosis; praziquantel