Drugs for treating urinary schistosomiasis
Christine V Kramer1,*, Fan Zhang2, David Sinclair3, Piero L Olliaro4
1Liverpool School of Tropical Medicine, Cochrane Infectious Diseases Group, Liverpool, UK
2Chongqing Medical University, School of Public Health and Management, Chongqing, China
3Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
4World Health Organization, UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland
Kramer CV, Zhang F, Sinclair D, Olliaro PL. Drugs for treating urinary schistosomiasis. Cochrane Database of Systematic Reviews 2014, Issue 8. Art. No.: CD000053. DOI: 10.1002/14651858.CD000053.pub3.
To read the full review please follow this link: DOI: 10.1002/14651858.CD000053.pub3.
What is urinary schistosomiasis and how is it treated?
Urinary schistosomiasis is a disease caused by infection of people with the parasitic worm Schistosoma haematobium. These worms live in blood vessels around the infected person's bladder and the worm releases eggs which are released in the person's urine. If the urine is passed into ponds or lakes, the eggs can hatch and infect people that are washing or swimming there. Infection can cause blood in the urine and if left untreated can eventually lead to anaemia, malnutrition, kidney failure, or bladder cancer. Urinary schistosomiasis is diagnosed by looking for worm eggs in the urine.
The disease occurs mainly in school-aged children and young adults in sub-Saharan Africa. The drug currently recommended for treatment is praziquantel, which can be given as a single dose, but other drugs such as metrifonate, artesunate, and mefloquine have also been evaluated.
After examining the research published up to 23th May 2014, we included 30 randomized controlled trials, enrolling 8165 children and adults.
What does the research say?
On average, the standard dose of praziquantel cures around 60% of people at one to two months after treatment (high quality evidence), and reduces the number of schistosome eggs in the urine by over 95% (high quality evidence).
Metrifonate, an older drug no longer in use, had little effect when given as a single dose but an improved effect when given as multiple doses two weeks apart. Two trials compared three doses of metrifonate with the single dose of praziquantel and found similar effects.
Two more recent trials evaluated a combination of artesunate and praziquantel compared to praziquantel alone. In one trial artesunate improved cure and in one it made no difference.
Future treatments for schistosomiasis could include combining praziquantel with metrifonate, or with artesunate, but these need to be evaluated in high quality trials.