Benzimidazoles in the treatment of alveolar echinococcosis: a comparative study and review of the literature

Mebendazole and albendazole are the drugs of choice for the treatment of al veolar echinococcosis. In this open-labelled observational study we present and evaluate the outcome of long-term treatment with these drugs and prese nt results of different treatment regimens. Thirty-five patients were start ed on either mebendazole or albendazole at the beginning of 1992 and follow ed for an average of 39 months (range 12-79 months). Treatment was classed as successful if the disease had not progressed for >1 year and if there we re no side-effects necessitating a change of treatment. Lack of progression was evaluated mainly using ultrasound and computed tomography and was furt her substantiated by laboratory tests and clinical findings. The overall su ccess rate was 97%. An initial regimen for cases of alveolar echinococcosis was recurrence-free in 71% of those treated with mebendazole and in 78% of those treated with albendazole. Four out of five cases with progressive di sease stabilized after the therapeutic regimen was changed. Seven patients received a continuous regimen with albendazole. These patients were observe d over an average of 28 months (range 13-50 months) without signs of progre ssion or significant side-effects. This open-labelled prospective study dem onstrates the high therapeutic efficacy of both mebendazole and albendazole with similar response rates in the treatment of alveolar echinococcosis. A lbendazole reduced costs by >40% and is easier for patients to take, furthe r arguing in favour of its preferred use. Albendazole in alveolar, echinoco ccosis is only licensed for intermittent application. None the less, contin uous treatment is safe and well tolerated and showed promising results when applied to patients in whom other treatment regimens had failed. It should thus be strongly considered in inoperable cases or progressive disease.