Trends in Parasitology
Volume 18, Issue 9, 1 September 2002, Pages 381-382
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Research update
New policies for using anthelmintics in high risk groups

https://doi.org/10.1016/S1471-4922(02)02386-3Get rights and content

Abstract

The ‘Informal Consultation on the Use of Praziquantel during Pregnancy/Lactation, and Albendazole/Mebendazole in Children under 24 Months’ was held 8–9 April 2002, in Geneva, Switzerland.

Section snippets

Experimental animal studies

Following toxicology studies in 1989, it was concluded that, by contrast to most other anthelmintic drugs, PZQ had no known detrimental effects in experimental animals, when given either acutely or chronically, and in doses well above those routinely administered to humans. Of specific importance, reproductive toxicity was studied in rats, rabbits and Syrian hamsters without negative effects [2]. In fact, drug treatment is allowed in breeding animals and lactating cows. When the patent on PZQ

Human toxicology

Since the release of PZQ, human toxicology data have been collected by the US Food and Drug Administration (Rockville, MA, USA) and Bayer. No cases have been uncovered which suggest adverse birth outcomes associated with PZQ use. Importantly, several pregnant women have been intentionally given PZQ for the treatment of cysticercosis – a treatment that uses the equivalent of the highest single dose of PZQ, repeated for 10–14 consecutive days, with no apparent adverse outcomes. Moreover, during

Risk–benefit analysis

The pivotal point of this conference rested on an analysis of the benefits of treatment. The argument to withhold PZQ until after pregnancy has always focused on the possibility of toxicity, rather than the detrimental effects of the untreated disease on the mother and child. If the morbidity induced by untreated infections is examined, three compelling arguments emerge.

First, we now know that schistosomiasis-induced organ damage can progress over relatively short periods of time (<9 months).

Conclusion

After two decades of clinical experience with these drugs and significant new experimental data, the conference recommended the following:

  • 1.

    Pregnant and lactating women are at least as susceptible as anyone else to end-organ morbidity due to schistosomiasis. Moreover, the fact that pathology can develop more rapidly in pregnant women than previously thought means that treatment delays are more likely to result in even more serious outcomes. Therefore, all infected pregnant and lactating women

Acknowledgements

We acknowledge Dirk Engels, Antonio Montresor and Lorenzo Savioli (Parasitic Diseases and Vector Control Unit, Dept of Communicable Diseases, Control, Prevention and Eradication, WHO, Geneva, Switzerland) for their invaluable contributions to this article and for organizing the meeting. We also acknowledge Anthony Dayan and Peter Folb for their major contribution to the outcome of the meeting.

References (7)

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