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Evidence summaries

Interventions for Treating Urinary Schistosomiasis

Praziquantel 40 mg/kg is effective for treating urinary schistosomiasis. Metrifonate appears to be an useful alternative. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 30 studies with a total of 8 165 subjects.

Praziquantel.On average, a single 40 mg/kg dose of praziquantel reduced the proportion of people still excreting eggs in their urine by around 60% compared to placebo at one to two months after treatment (treatment failure: RR 0.42, 95% CI 0.29 to 0.59, 864 participants, 7 trials). The proportion of people cured with praziquantel varied substantially between trials, from 22.5% to 83.3%, but was higher than 60% in five of the seven trials. At one to two months following praziquantel treatment at 40 mg/kg, the mean number of schistosome eggs in the urine was reduced by over 95% in five out of six trials (678 participants, 6 trials).Splitting praziquantel 40 mg/kg into two doses over 12 hours probably has no benefits over a single dose, and in a single trial of 220 participants the split dose caused more vomiting (RR 0.5, 95% CI 0.29 to 0.86) and dizziness (RR 0.39, 95% CI 0.16 to 0.94).

Metrifonate.A single dose of metrifonate 10 mg/kg reduced egg excretion (210 participants, 1 trial, at 8 months), but was only marginally better than placebo at achieving cure at one month (RR 0.83, 95% CI 0.74 to 0.94, 142 participants, 1 trial). In a single trial comparing one, two and three doses, the absolute number of participants cured improved from 47% after one dose to 81% after three doses (93 participants, 1 trial).Two small trials compared 40 mg/kg single dose praziquantel with two or three doses of 10 mg/kg metrifonate and found no clear evidence of differences in cure (metrifonate 2 x 10 mg/kg at one month: RR 1.03, 95% CI 0.8 to 1.34, 72 participants,1 trial; metrifonate 3 x 10 mg/kg at three months: RR 0.33, 95% CI 0.07 to 1.57, 100 participants, 1 trial. In one trial both drugs performed badly and in one trial both performed well.

    References

    • Kramer CV, Zhang F, Sinclair D et al. Drugs for treating urinary schistosomiasis. Cochrane Database Syst Rev 2014;8():CD000053. [PubMed]

Primary/Secondary Keywords