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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 (Ref.no.)

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