Cysticercosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Medical Therapy
Not all cases of cysticercosis are treated and the use of albendazole and praziquantel is controversial.
Pharmacotherapy
Infections are generally treated with antiparasitic drugs in combination with antiinflammatory drugs.
Several studies suggest that albendazole (conventional dosage 15 mg/kg/day in 2 divided doses for 15 days) may be superior to praziquantel (50 mg/kg/day for 15 days) for the treatment of neurocysticercosis. In comparative clinical trials, albendazole was equivalent or superior to praziquantel in reducing the number of live cysticerci. A recent placebo-controlled, double-blinded trial demonstrated that albendazole treatment (400 mg twice daily plus 6 mg dexamethasone QD for 10 days) significantly decreased generalized seizures over 30 months of follow-up.
More prolonged treatment courses (e.g. 30 days of albendazole, which may be repeated) may be needed for extraparenchymal or extensive disease. Albendazole is more likely to be effective against extraparenchymal forms of the disease because of better penetration than praziquantel into the CSF. Another possible contributing factor to the greater efficacy of albendazole is that serum and CSF metabolite levels appear to be potentiated by concomitant corticosteroids, whereas praziquantel levels are depressed. Albendazole, unlike praziquantel, has been reported to be effective in giant subarachnoid cysticerci (racemose cysts) and in extraocular muscle cysts. Both drugs appear to have a role in therapy, since cases that have not responded to one of the drugs have been reported to respond to the other.