Medical treatment of liver hydatidosis

There are currently three treatment options for Liver hydatidosis: urgery, which remains the mainstay of radical treatment; ultrasound-guided aspirati on (puncture/aspiration/injection/reaspiration-PAIR); and chemotherapy with benzimidazole compounds (albendazole and mebendazole). Chemotherapy is a n oninvasive treatment and is less limited by the patient's status than surge ry or PAIR but is not ideal when used alone. Albendazole, the drug most oft en used, appears to have the greatest efficacy of any agent used so far; ne vertheless, apparent cure (shrinkage or disappearance of cysts) ranges only between 20% and 30% of cases. The possible contribution of perioperative c hemotherapy offers the prospect of preventing recurrent disease, but it req uires more clinical trials to establish that pre- or postoperative chemothe rapy does prevent recurrence. The main adverse events are related to change s in liver enzyme levels and bone marrow suppression. About 10% to 20% of p atients develop self-limited, reversible rises in transaminase Levels; clin ically severe pancytopenia or agranulocytosis is exceptional. Alopecia is o bserved during long-term treatment with albendazole. In all cases these eve nts disappear once treatment is interrupted. According to the World Health Organization guidelines, chemotherapy is the preferred treatment when the d isease is inoperable, when surgery or PAIR is not available, or when the cy sts are too numerous. Another important indication for chemotherapy is the prevention of secondary echinococcosis. There is not yet formal consensus, as the efficacy and safety of some of the methods require further evaluatio n before we can establish comprehensive guidelines for the medical treatmen t of hydatidosis.