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Table 2 Main characteristics of the reviews included in the qualitative analysis

From: Medical treatment of cystic echinococcosis: systematic review and meta-analysis

Author/s Year ( Location, Country Study design Participants Sample size (N) No. cysts Cyst location Objective Anthelminthic drugs Results/Conclusions
Bygott JM, et al. 2009 l [14] London, England A literature review In vitro/vivo animal studies, human studies No data No data Liver, lung, intra-abdominal To review the evidence on the use of PZQ in treatment of cystic hydatid disease from in vitro and in vivo animal studies, human clinical studies and human case reports. PZQ Insufficient published evidence to support a clear recommendation for the use of PZQ in prolonged chemotherapy for established hydatid disease for which surgery is not indicated or in severe disseminated disease and further work is necessary.
Horton RJ. 1997 [19] Brentford, UK A systematic review Adult and pediatric patients (age range, 6–83) 3760 No data Principally in the liver, with lung infection being the second most common To review the efficacy and safety of ABZ obtained in the last 12 years. ABZ ABZ has been shown to be a useful advance in the management of CE both when used as sole treatment or as an adjunct to surgery or other treatments. Efficacy seems to increase with exposure up to 3 months in the commoner cyst sites.
Kern P, et al. 2003 [20] Ulm, Germany A literature review Adult and pediatric patients No data No data Liver, lung, kidney, spleen, muscles, abdominal and pelvic cavity,… To review clinical presentation and medical treatment vs conservative treatment and outcome Echinococcus granulosus infection. ABZ or MBZ or PZQ Of major importance in the management of CE is long-term observation and longitudinal monitoring. Liver cysts relapse more frequently than do cysts at other sites, presumably because of greater proliferative potential of the metacestode tissue remaining in the hepatic environment. Further cycles of benzimidazole treatment of patients with recurrences were again well tolerated and effective. It was suggested that the higher metabolic activity of relapsed cysts makes them more susceptible to the action of benzimidazole carbamates.
Stamatakos M, et al. 2009 [27] Athens, Greece A literature review Adult and pediatric patients No data No data Liver, lung, and peritoneal cysts To clarify anthelminthic treatment as an alternative hydatic cyst therapy, its indications and contraindications. ABZ or MBZ ABZ and MBZ have a favourable effect in patients suffering from multiorgan and multicystic disease, in inoperable primary liver or lung echinococcosis, and they can also prevent secondary echinococcosis. Chemotherapy is contraindicated for large cysts that are at risk to rupture and for inactive or calcified cysts. The main adverse events are related to changes in liver enzyme levels. The best efficacy is observed with liver, lung, and peritoneal cysts. Certain various factors influence the therapeutic results of medical treatment. The vast majority of the recurring cysts show good susceptibility to re-treatment.
Stojkovic M, et al. 2009 [6] Heidelberg, Germany (6 Centers: Rome, Bulgaria, Romania, Palermo, Greece, Turkey) A systematic review Adult and pediatric patients 711 1159 Liver and peritoneal cysts To describe cyst outcome after initiation of benzimidazole treatment, with outcome defined by cyst stage determined by ultrasound following the WHO classification of 2001. ABZ or MBZ The overall efficacy of benzimidazoles has been overstated in the past. There is an urgent need for a pragmatic randomised controlled trial. The clarification of the efficacy of benzimidazoles in CE treatment is of paramount importance since benzimidazoles are the only drugs currently available to treat this neglected disease.
Yasawy MI 2001 [31] Saudi Arabia A literature review Clinical cases and animal studies No data No data Multi-organ To review the efficiency of benzimidazole (ABZ) and isoquineline (PZQ). ABZ or PZQ Combination therapy is more effective and requires a shorter period of treatment than ABZ alone. Pre- and postoperative prophylactic therapy reduce risk of spillage and dissemination during surgery and percutaneous aspiration.
  1. *ABZ Albendazole, PZQ Praziquantel, MBZ Mebendazol