Echinococcosis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Both cystic echinococcosis and alveolar echinococcosis are complicated to treat, sometimes requiring extensive surgery and/or prolonged drug therapy. There are 3 options for the treatment of cystic echinococcosis: anti-infective drug treatment, percutaneous treatment of the hydatid cysts with the PAIR (Puncture, Aspiration, Injection, Re-aspiration) technique and surgery.

Medical Therapy

Cystic echinococcosis stage 1 of less than 5 cm

• Preferred regimen: Albendazole 10 to 15 mg/kg per day q12
• Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)

Cystic echinococcosis stage 1 of more than 5 cm

• Preferred regimen: Albendazole 10 to 15 mg/kg per day q12 and Puncture, Aspiration, Injection, Re-aspiration (PAIR)
• Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)

Cystic echinococcosis stage 2 of any size

• Preferred regimen: Albendazole 10 to 15 mg/kg per day q12 and either modified catheterization or surgery
• Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)

Cystic echinococcosis stage 3 of any size

• Preferred regimen: Albendazole 10 to 15 mg/kg per day q12 and either modified catheterization or surgery
• Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)

World Health Organization classification of cystic echinococcosis and treatment stratified by cyst stage

WHO stage	Description	Stage	Size	Preferred treatment	Alternate treatment
CE1	Unilocular unechoic cystic lesion with double line sign	Active	<5 cm	Albendazole alone	PAIR
			>5 cm	Albendazole + PAIR	PAIR
CE2	Multiseptated, "rosette-like" "honeycomb" cyst	Active	Any	Albendazole + either modified catheterization or surgery	Modified catheterization
CE3a	Cyst with detached membranes (water-lily sign)	Transitional	<5 cm	Albendazole alone	PAIR
			>5 cm	Albendazole + PAIR	PAIR
CE3b	Cyst with daughter cysts in solid matrix	Transitional	Any	Albendazole + either modified catheterization or surgery	Modified catheterization
CE4	Cyst with heterogenous hypoechoic/hyperechoic contents; no daughter cysts	Inactive	Any	Observation	-
CE5	Solid plus calcified wall	Inactive	Any	Observation	-