Background
Methods
Search strategy and criteria for study selection
Data extraction and quality assessment
Meta-analysis methods
Results
Literature search
Qualitative synthesis
Author/s Year (Ref.no.) | Location, Country | Study design (follow-up period) | Participants | Sample size(N) | No. cysts | Cyst location | Objective | Anthelminthic drugs | Results/Conclusions |
---|---|---|---|---|---|---|---|---|---|
Aktan AO, et al. 1996 [13] | Istanbul, Turkey | A non-randomized controlled trial | Adult patients | 70 | 89 | Liver | To evaluate the effect of preoperative ABZ* treatment (3-weeks) in two groups: 1st group (experimental group) ABZ 3 weeks before surgery, 2nd group (control group) surgery (no preoperative treatment). | ABZ | The ICP values of viable cysts in the 1st group were significantly lower (p < 0.05). The number of non-viable cysts was also significantly higher in the 1st group (p < 0.05). ABZ has proved to be effective in decreasing the viability of liver hydatid cysts when given for 3 weeks preoperatively. |
Di Matteo G, et al. 1996 [15] | Rome, Italy | A prospective, descriptive, non-comparative study (1985–1992) | Adult patients (mean age, 42) | 95 | No data | Liver | To show that radical surgery is most effective when it is associated with medical therapy of benzoimidazole drugs (MBZ) pre- and post-operatively. | MBZ* | The most effective treatment for echinococcus cystic disease of the liver is radical surgery. Results are best when surgery is combined with medical therapy of benzoimidazole drugs (MBZ) given pre- and post-operatively. |
Doğru D, et al. 2005 [16] | Ankara, Turkey | A retrospective study | Pediatric patients | 82 | 102 | Lung | To demonstrate the safety and efficacy of medical treatment. | MBZ vs ABZ | The cure and the failure rates were statistically insignificant in cysts treated with MBZ and ABZ; however statistically significantly more cysts were improved with ABZ. The results were statistically insignificant between continuous and cyclic ABZ treatment. There was a positive, weak and statistically significant correlation between the cyst size and treatment results. These results cannot recommend a standard treatment regimen as the duration of treatment should be individualized for each patient. |
el-Mufti M, et al. 1993 [17] | Benghazi, Libya | A prospective, descriptive, non-comparative study | Adult patients | 40 | 63 | Multi-organ | To assess the effectiveness of ABZ before surgery. | ABZ | It is suggested that patients suffering from uncomplicated hydatid disease should be given the benefit of a trial course of ABZ therapy before surgery. |
Ghoshal AG, et al. 2012 [18] | Kolkata, India | A retrospective study (5 years) | Adult patients | 106 | No data | Lung | To determine the presentation, treatment (ABZ and surgery) and outcome of hydatid disease of lung. | ABZ | Surgery is a safe and effective way of treatment for thoracic hydatid cyst along with perioperative ABZ therapy. There is a scope for chemotherapy with ABZ in inoperable cases. |
Larrieu E, et al. 2004 [21] | Rio Negro, Argentina | A prospective cohort study (5–6 years) | Pediatric patients | 5745 Exposed cohort = 4644 Unexposed cohort = 1101 | No data | Abdominal | To evaluate the results of a program carried out in endemic areas of the Province of Río Negro, Argentina, during the years 1997–2002 in asymptomatic children, screnning. | ABZ | Treatment with ABZ confirmed its action in modifying the prognosis of CE, presenting positive effects in 76% of patients receiving the drug. None of the treated cases required surgery. The combination of ultrasonographic screening and ABZ treatment showed promising results. |
Li T, et al. 2011 [22] | Sichuan, China | A prospective, descriptive, non-comparative study | Adult patients | 49 | No data | Abdominal | A post-treatment follow-up study was carried out to assess the effectiveness of community based use of cyclic ABZ treatment in Tibetan CE cases. | ABZ | Cyclic ABZ treatment proved to be effective in the great majority of CE, but periodic abdominal ultrasound examination was necessary to guide appropriate treatment. Serology with recombinant antigen B could provide additional limited information about the effectiveness of ABZ in CE cases. Oral ABZ for over 18 months was more likely to result in CE cure. |
Mikić D, et al. 1998 [23] | Republic of Serbia | A retrospective study | Adult and pediatric patients (female age range, 9–83; males age range, 6–72) | 119 | No data | Liver | To value the efficacy of ABZ and surgery. | ABZ | Surgical removal of the cyst takes a leading place in the treatment of hepatic echinococcosis. However, in well-selected cases and in the patients with high surgical risk, anthelminthic therapy and PD of echinococcus cyst are of more significance. |
Nahmias J, et al. 1994 [24] | Moztkin, Israel | A prospective, descriptive, non-comparative study (3–7 years) | Adult patients | 68 | No data | Multi-organ | To assess long-term efficacy of ABZ. | ABZ | Follow-up for 3–7 years showed that this treatment alone eradicated the cysts in many patients; in most of the remainder, disease progression stopped. No patient worsened but a recurrence occurred in two patients at about 56 months. |
Perez Molina JA, et al. 2011 [10] | Madrid, Spain | A case series | Adult patients (age range, 27–68) | 7 | No data | Multi-organ | To describe the clinical effectiveness and tolerability of nitazoxanide, combined with ABZ, with or without PZQ*, in patients affected by disseminated chronic CE. | ABZ vs ABZ + PZQ | Nitazoxanide combination therapy seems to be active for disseminated CE affecting soft tissues, muscles, or viscera, and apparently it has no role in chronic and extensive bony lesions. |
Redzić B, et al. 1995 [24] | Republic of Serbia | A prospective, descriptive non-comparative study (from 1989 to 1993) | Adult patients | 73 | No data | Liver | To value the efficacy of PZQ. | PZQ | The drug treatment was the therapy of choice in patients with Echinococcus granulosus. It should be given prophylactically, preoperatively, to sterilize the cyst and also as a curative treatment. |
Salinas JL, et al. 2011 [26] | Lima, Perú | A retrospective study (from January 1997 to December 2007) | Adult patients (mean age at diagnosis, 51 ± 14) | 27 | No data | Liver | To ascertain factors associated with the success of ABZ in the treatment of non-complicated hepatic CE, and to establish the frequency of long-term worsening and recurrence of disease after treatment completion in Peru. | ABZ | Long-term hepatic CE treatment outcomes and the success rate of ABZ were modest (3 cycles are few and needed treatment 6–12 months). It’s necessary to investigate into alternate therapeutic strategies for this neglected disease. |
Tarnovetchi C, et al. 2010 [28] | Romania | A retrospective study (2004–2009 and 2000–2009) | Pediatric patients (age range, 2–17) | 111 | No data | Abdominal | To value the efficacy of ABZ and surgery (Lagrot partial pericystectomy). | ABZ | The treatment includes both surgical and medical means. There is a relatively high rate of postoperative complications (although some of them being minor) in 31 patients. |
Todorov T, et al. 1992 [29] | Sofia, Bulgaria | A prospective descriptive study | Adult and pediatric patients (age range, 6–70) | 51 (28 MBZ, 23 ABZ) | No data | Multi-organ | To test the efficacy of MBZ and ABZ. | MBZ or ABZ | Treatment with MBZ was successful in 8 (28.6%), partially successful in 8 (28.6%) and unsuccessful in 12 (42.8%). Treatment with ABZ was successful in 10 (43.5%), partially successful in 10 (43.5%) and unsuccessful in 3 (13.0%). |
Yasawy MI, et al. 1993 [30] | Riyah, Saudi Arabia | A case series | Adult patients | 4 | No data | Pelvic, abdominal and thoracic | To value the response to combined medical treatment (ABZ and PZQ). | ABZ plus PZQ vs ABZ | This preliminary report shows that the response to combined treatment is better and much quicker compared to ABZ alone. |
Yilmaz Y, et al. 2006 [32] | Van, Turkey | A retrospective study (10 years) | Adult and pediatric patients | 372 (of them, 8 urinary hydatid disease) | No data | Liver, spleen, brain and kidneys(7)-retrovesical area(1) | To discuss therapeutic options and treatment results according to current literature. | ABZ | Treated surgically (271 cases) and drained percutaneously (99 cases). Kidneys were removed totally (4 cases), cystectomy and omentoplasty was performed in one case. ABZ was administered to 192 patients. |
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. |
Quantitative synthesis using meta-analysis
Author/s. Year (Ref.no.) | Location Country | Objectivea | Study design | Trial time period | Participants | Sample size (N)b | No. Cysts | Patients characteristicsc | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Bildik N, et al. 2007 [33] | Kartal-Istanbul, Turkey | To evaluate the efficacy of preoperative ABZ therapy | A randomized controlled trial | 1998–2003 | Patients with isolated hydatid cysts of the liver | 84 | 84 | Sex (M/F), 36/48 Range age (yr), (14–67) | ||||
Group I | Group II | Group III | Group IV-control group | |||||||||
n = 21 No.cyst = 21 | n = 21 No.cyst = 21 | n = 21 No.cyst = 21 | n = 21 No.cyst = 21 | |||||||||
Cobo F, et al. 1998 [9] | Pamplona-Navarra, Spain | To compare the effects of a combined medication of ABZ plus PZQ vs ABZ alone in the preoperative treatment | A randomized controlled trial | 1990–1997 | Patients with intra-abdominal hydatidosis | 62 → 47 | No data | Group I | Group II | Group III | ||
n Sex (M/F) Age (yr, mean ± SD[range]) Cyst/patient (mean[range]) | 19 → 12 6/6 47.9 (19–67) 1.17(1–3) | 17 → 14 11/3 51.1 (31–70) 1.57 (1–4) | 26 → 21 9/12 46.9 (18–75) 1.43 (1–5) | |||||||||
Davis A, et al. 1986 [34] | WHO, Geneva, Switzerland | First phase: Studies coordinated by the WHO were conducted in seven clinical centers on the chemotherapy of human echinococcosis with MBZ, ABZ and FBZ. | A multicenter randomized clinical trials (5 clinical centers, Beirut, Paris, Rome, Sofia and Zurich) | 1982–1984 | Adults patients, mainly, only 7% below 15 years | 121 | 121 | MBZ | FBZ | ABZ | ||
n = 121 Sex (M/F) = 63/58 No.cyst = 402 | 85 38/47 348 | 6 3/3 18 | 30 22/8 36 | |||||||||
Davis A, et al. 1989 [35] | WHO, Geneva, Switzerland | Second phase: To value the efficacy of ABZ and MBZ in human CE coordinated by WHO. | A multicenter randomized clinical trials (4 clinical centers, Beirut, Paris, Rome and Sofia) | 1985–1987 | Adults patients, mainly, only 4% below 15 years | 176 → 112 | 106 | ABZ | MBZ | |||
n = 112 Sex (M/F) = 47/65 Follow-up < 12 months = 44 Follow-up > 12 months = 68 No.cyst patients > 12 months = 106 | 67 27/40 21 46 76 | 45 20/25 23 22 30 | ||||||||||
Franchi C, et al. 1999 [36] | Rome, Italy | To evaluate the results obtained during long-term follow-up of a series of patients treated with benzimidazole carbamate | A randomized controlled trial | 1982–1997 | Patients with hydatidosis located in various body organs | 448 | 929 | Sex (M/F), 191/257 Age (yr, mean[range]), 52 (4–86) Follow-up (months, mean[range]), 22 (12–170) | ||||
MBZ | ABZ | |||||||||||
n No.cyst | 125 289 | 323 640 | ||||||||||
Gil-Grande LA, et al. 1993 [37] | Madrid, Spain | To assess the efficacy and safety of ABZ in a medical treatment | A randomized controlled trial | 1987–1991 | Patients with intra-abdominal hydatid disease | 66 → 55 | 55 | Group A | Group B | Control gr. | ||
n Sex (M/F) Age (yr, mean ± SD) No.cyst | 18 10/8 41.7 ± 14.2 18 | 19 12/7 47.3 ± 13.9 19 | 18 9/9 41.2 ± 17.3 18 | |||||||||
Keshmiri M, et al. 1999 [38] | Mashhad, Iran | To compare the effects of ABZ vs placebo in the treatment of hydatid cysts | A triple-blind parallel randomized clinical trial | 1994–1995 | Patients with hydatid cysts of the lung/pulmonary echinococcosis | 20All p. 15Treat. | 179All p. 150Treat. | Treatment group | Placebo group | |||
All p.d | Treat.d | All p.d | Treat.d | |||||||||
n Sex (M/F) Age (yr, mean ± SD) No.cyst Cyst/patient | 14 8/6 41 ± 15 137 12.2 ± 13.4 | 11 5/6 40 ± 17 124 16.3 ± 13.9 | 6 3/3 39 ± 17 42 10.8 ± 13.7 | 4 3/1 45 ± 17 26 8.8 ± 7.6 | ||||||||
Keshmiri M, et al. 2001 [39] | Mashhad, Iran | To evaluate the effect of ABZ on hydatid disease | A double-blind parallel-group randomized clinical trial | 1994–1995 | Patients with hydatid cysts of the lung and abdomen (including liver) | 29All p. 21Treat. | 240 All p. 203Treat. | Treatment group | Placebo group | |||
All p.d | Treat.d | All p.d | Treat.d | |||||||||
n Sex (M/F) Age (yr, mean ± SD) No.cyst Cyst/patient | 22 11/11 41.4 ± 15.9 191 8.6 ± 9.0 | 17 7/10 40.5 ± 17.3 172 9.8 ± 9.9 | 7 4/3 35.4 ± 18.3 49 7.1 ± 6.5 | 4 3/1 45.5 ± 17.4 31 7.8 ± 6.1 | ||||||||
Khuroo MS, et al. 1993 [40] | Srinagar, Kashmir, India | To compare the safety and efficacy of percutaneous drainage (PD) with ABZ therapy | A randomized controlled trial | 1989–1992 | Patients with hepatic hydatid cysts | 30 | 33 | PD | ABZ-PD | ABZ | ||
n Sex (M/F) Age (yr, mean ± SD) (Range age) No.cyst Size Ø (cm, mean ± SD) Volume (cm3, mean ± SD) | 10 4/6 36.7 ± 12.3 (12–55) 10 9.2 ± 4.4 686 ± 651 | 10 3/7 41.3 ± 14.9 (12–64) 12 10.8 ± 3.0 835 ± 528 | 10 4/6 39.5 ± 14.4 (18–60) 11 8.8 ± 4.5 642 ± 717 | |||||||||
Mohamed AE, et al. 1998 [8] | Riyadh, Saudi Arabia | To evaluate the effect of different regimens of medical treatment | Two prospective randomized intervention studies | 1st study, 1985–1990 2nd study, 1990–1998 | Adult Saudi patients with hydatid disease at the Armed Forces Hospital | 1st, 22 2nd, 19, Total,41 | No data | 1st, ALB | 2nd, ABZ+PZQ | |||
n = 22 | n = 19 | |||||||||||
Shams-UI-Bari, et al. 2011 [41] | Srinagar, Kashmir, India | To assess the effect of preoperative ABZ therapy on the viability of protoscoleces at the time of surgery | A randomized controlled trial | 2002–2003 + follow-up 5 years | Patients with diagnosis of hydatid liver disease | 72 | 72 | Sex (M/F), 39/33 Range age (yr), (17–66) | ||||
Group A-Surgery | Group B-ABZ+surg+ABZ | |||||||||||
n Sex (M/F) Age (yr, mean ± SD[range]) No.cyst | 36 19/17 36.75 ± 11.34(16–64) 36 | 36 20/16 36.78 ± 11.79(17–62) 36 |
Author/s. Year(Ref.no.) | Cyst location | Mean cyst size(cm) | Treatmenta | Endpoint | Main quantitative findings* | ||
---|---|---|---|---|---|---|---|
Bildik N, et al....... 2007 [33] | Liver | Non-registered information | G-I: ABZ (10 mg/kg/day 1 month before surgery) G-II: ABZ (10 mg/kg/day 2 months before surgery) G-III: ABZ (10 mg/kg/day 3 months before surgery) G-IV (control gr.): surgery (no preoperative therapy) | Viability of the scoleces | Intact | Dead | |
G-I G-II G-III G-IV | 10 7 2 17 | 11 14 19 4 | |||||
Cobo F, et al. 1998 [9] | Liver | Non-registered information | G-I: ABZ (10 mg/kg/day 1 month before surgery) G-II: ABZ (20 mg/kg/day 1 months before surgery) G-III: ABZ (10 mg/kg/day) + PZQ (25 mg/kg/day 1 month before surgery) | Protoscolex viability. ABZ sulphoxide levels in serum and cyst fluid | Protoscoleces viability | ||
G-III and G-I G-III and G-II | p = 0.004 p = 0.030 | ||||||
ABZ sulphoxide levels | |||||||
G-III and G-I G-III and G-II | p = 0.016 p = 0.034 | ||||||
Davis A, et al. 1986 [34] | Liver, lung, other organs | Non-registered information | MBZ (13 to 136.4 mg/kg/day) FBZ (37.5 to 54.5 mg/kg/day) ABZ (9.8 to 15.4 mg/kg/day) | Results: -success -partial success -improvement -no success | MBZ | FBZ | ABZ |
8 (9.4) 4 (4.7) 40 (47.1) 33 (38.8) | 1 - - 5 | 5 (16.7) 4 (13.3) 14 (46.7) 7 (23.3) | |||||
Davis A, et al. 1989 [35] | Liver, lung, other organs | Non-registered information | ABZ (10 mg/kg/day 1 month) MBZ (1.5 to 4.5 g/kg/day, children half of the adult dose) | Results: -success -favourable effect -no success | Follow-up | ABZ | MBZ |
< 12 months: -success -favourable effect -no success no evaluation > 12 months: -success -favourable effect -no success | 21 (100) - 13 (62) 5 (24) 3 (14) 46 (100) 18 (39) 18 (39) 10 (22) | 23 (100) - 6 (26) 13 (57) 4 (17) 22 (100) 3 (14) 14 (64) 5 (23) | |||||
Franchi C, et al. 1999 [36] | Liver, abdomen, lung | Non-registered information | G-I: MBZ (50 mg/kg/day) G-II: ABZ (10–12 mg/kg/day) Both drugs in continuous 3- to 6-months cycles | Chest radiographic, ultrasonography, morphological changes and sonographic classification by Caremani et al | Cysts | G-I | G-II |
Treated Evaluated Changed Further deg. Relapse | 289 271 152 34 37 | 640 611 502 110 134 | |||||
Gil-Grande LA, et al. 1993 [37] | Liver or abdominal | G-A: 10.4 ± 4.1 G-B: 8.9 ± 4.3 G-C: 10.5 ± 5.1 | G-A: ABZ (10 mg/kg/day 1 month before surgery) G-B: ABZ (10 mg/kg/day 3 months before surgery) G-C (control group): surgery (no ABZ treatment) | Protoscolex and cyst viability (patients/mice). Echographic changes | p-value | ||
Viability of protoscolices 0.041 Intraperitoneal inoculation 0.167 Membrane disruption < 0.001 Echographic changes 0.038 | |||||||
Keshmiri M, et al. 1999 [38] | Lung | E.gr: cm3 ± SD, 29.6 ± 50.5All 27.1 ± 45.8Treat. C.gr: cm3 ± SD, 18.3 ± 49.5All 25.1 ± 63.3Treat. | Experimental group: ABZ (10–15 mg/kg/day 6 months) Control group: placebo | Radiological or ultrasonic findings. Response to treatment was classified: -Cured -Improved -No change -Worsened (Caremani et al) | ABZ | Placebo | |
No. cysts Worse No change | 124 9 (7) 32 (26) | 26 10 (39) 13 (50) | |||||
Decreased | |||||||
> 25% (p < 0.001) > 50% (p < 0.001) > 75% (p = 0.067) Disappeared (p = 0.075) | 83 (67) 60 (48) 36 (29) 16 (13) | 3 (12) 1 (4) 1 (4) 0 (0) | |||||
Keshmiri M, et al. 2001 [39] | Lung, abdomen (including liver) | E.gr: cm3 ± SD, Lung, 29.6 ± 50.5All 27.1 ± 45.8Treat. Abdomen (liver), 198.1 ± 403.7All 212.7 ± 426.2Treat. C.gr: cm3 ± SD, Lung, 18.3 ± 49.5All 25.1 ± 63.3Treat. Abdomen (liver), 74.0 ± 130.8All 91.9 ± 155.4Treat. | Experimental group: ABZ (400 mg twice a day, in 3 cycles of 6 weeks with 2 weeks between cycles) Control group: placebo | Volume. Ultrasonography and Computed tomography changes: 7 types, T1-T7. Response to treatment was classified: -Cured -Improved -No change -Worsened (Caremani et al) | ABZ | Placebo | |
No. cysts Worse (p < 0.001) No change Improved (p < 0.001) Cure (p = 0.081) | 172 15 (8.7) 23 (13.4) 117 (68) 17 (9.9) | 31 11 (35.5) 16 (51.6) 4 (12.9) 0 (0.0) | |||||
Khuroo MS, et al. 1993 [40] | Liver | cm / cm3, mean ± SD At entry into the study vs the end of study PD, 9.2 ± 4.4 vs 5.1 ± 3.9 686 ± 651 vs 297 ± 515 ALB-PD, 10.8 ± 3.0 vs 4.8 ± 3.4 835 ± 528 vs 260 ± 389 ALB, 8.8 ± 4.5 vs 8.0 ± 5.0 642 ± 717 vs 606 ± 741 | G-I: PD G-II: ABZ (10 mg.kg-1.day-1 for 8 weeks) plus PD G-III: ABZ alone | At entry into the study vs the end of study: -Clinical response -Cyst size -Cyst echopattern -Hydatid serology -Complications | p-value | ||
Clinical response | < 0.001 | ||||||
< 0.005 | |||||||
Cyst diameter Cyst volume Cyst echopattern Hydatid serology | < 0.05 < 0.01 < 0.01 NS | ||||||
Mohamed AE, et al. 1998 [8] | 1st, Liver(18), lung(1), multiple cyst(3). 2nd, Liver(13), lung(2), others:pelvis, mediastinum, kidney, spinal(4) | Non-registered information | 1st, ABZ (400 mg twice day four weeks/two-week drug free period) 2nd, ABZ (400 mg twice a day) + PZQ (50 mg/kg) | Ultrasound and computed tomography changes, magnetic resonance, hydatid serology and chest-X-ray. Complete cure rates | ABZ | ABZ + PZQ | |
No. patients | 22 | 19 | |||||
Disappearance | 8 (36.4) | 9 (47.4) | |||||
Liver | 7/13 | ||||||
Lung | 2/2 | ||||||
Reduction | 5 (22.7) | 9 (47.4) | |||||
Liver | 5/13 | ||||||
Others | 4/4 | ||||||
No change | 2 (9.1) | 1 (5.2) | |||||
Increase | 0 | 0 | |||||
Shams-UI-Bari, et al. 2011 [41] | Liver | Non-registered information | Group A: surgery. Group B: ABZ (10 mg/kg/day 12 weeks) + surgery + ABZ (10 mg/kg/day 12 weeks) | Viability, motility of the scolices and their ability to exclude 5% eosin, under immediate microscopy. Recurrence. | G-A | G-B | |
Type I Type II Type III Type IV Viable Non-viable, p < 0.01 Recurrence, p < 0.05 | 12 (33.3) 10 (27.2) 8 (22.2) 6 (16.6) 36 (100) 0 (0) 6 (16.6) | 11 (30.5) 11 (30.5) 10 (27.7) 4 (11.1) 2 (5.5) 34 (94.5) 0 (0) |