Treatment algorithm
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer
praziquantel
Acute schistosomiasis refers to systemic symptoms that occur several months (typically 4 to 8 weeks) after infection. Symptoms are the result of hypersensitivity to migrating larvae and early egg deposition.
Praziquantel, an antiparasitic drug, is the treatment of choice for infection caused by all major Schistosoma species. People across all age groups benefit significantly from treatment with praziquantel to cure infection, reduce worm burden, and reduce other schistosomiasis-related morbidities.[6][71]
The World Health Organization (WHO) recommends praziquantel in all infected people regardless of age including adults, pregnant women after the first trimester, breastfeeding women, and preschool-aged children ≥2 years of age. Data is limited in the first trimester of pregnancy. Available studies did not find any major safety events (including fetal outcomes); however, the number of women in the first trimester of pregnancy included in the data was low. Data is also limited in children <2 years of age. The decision to administer praziquantel to children <2 years of age should be based on testing and clinical judgement. Specific paediatric formulations of praziquantel are in development. If paediatric formulations are not available, the dose may be crushed in soft food.[6]
Treatment with praziquantel is well tolerated across all age groups with only transient, mild, adverse effects (e.g., headache, dizziness, abdominal pain). People with high-intensity infections had a higher incidence of mild adverse effects.[6]
Dose regimens may vary, and typically depend on the Schistosoma species. The US Centers for Disease Control and Prevention recommends three-times-daily dosing for S japonicum or S mekongi, and twice-daily dosing for S haematobium, S mansoni, or S intercalatum.[71] Consult your local guidance for dose regimens. A single dose is usually curative; however, repeat treatment may be needed in some patients in order to improve efficacy.[71]
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Primary options
praziquantel: children ≥2 years of age and adults: 20 mg/kg orally two or three times daily (depending on species) for 1 day
praziquantel
Chronic schistosomiasis refers to granulomatous and fibrotic disease that occurs years after exposure. Chronic disease is associated with granulomatous inflammation in response to parasite eggs and the resulting damage to affected organs. Ulceration of tissue (bladder or intestinal) from migrating eggs also produces symptoms. Chronic diarrhoea may occur with inflammation of the bowel wall due to egg deposition.[19][38][55]
Patients with Schistosoma eggs detected in urine, stool, or tissue biopsy should be treated. In addition, any previously untreated patient with positive serology should be treated.
Praziquantel, an antiparasitic drug, is the treatment of choice for infection caused by all major Schistosoma species. People across all age groups benefit significantly from treatment with praziquantel to cure infection, reduce worm burden, and reduce other schistosomiasis-related morbidities.[6][71]
The World Health Organization (WHO) recommends praziquantel in all infected people regardless of age including adults, pregnant women after the first trimester, breastfeeding women, and preschool-aged children ≥2 years of age. Data is limited in the first trimester of pregnancy. Available studies did not find any major safety events (including fetal outcomes); however, the number of women in the first trimester of pregnancy included in the data was low. Data is also limited in children <2 years of age. The decision to administer praziquantel to children <2 years of age should be based on testing and clinical judgement. Specific paediatric formulations of praziquantel are in development. If paediatric formulations are not available, the dose may be crushed in soft food.[6]
Treatment with praziquantel is well tolerated across all age groups with only transient, mild, adverse effects (e.g., headache, dizziness, abdominal pain). People with high-intensity infections had a higher incidence of mild adverse effects.[6]
Dose regimens may vary, and typically depend on the Schistosoma species. The US Centers for Disease Control and Prevention recommends three-times-daily dosing for S japonicum or S mekongi, and twice-daily dosing for S haematobium, S mansoni, or S intercalatum.[71] Consult your local guidance for dose regimens. A single dose is usually curative; however, repeat treatment may be needed in some patients in order to improve efficacy.[71]
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Repeat urine or stool testing for Schistosoma eggs is recommended 2 months after treatment, to assure clearance of infection. Cure rate is >80% to 90% with a single treatment in many series, but lower rates of success have been reported.[20][75][76]
Primary options
praziquantel: children ≥2 years of age and adults: 20 mg/kg orally two or three times daily (depending on species) for 1 day
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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer
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