Benzimidazoles in the treatment of alveolar echinococcosis: a comparative study and review of the literature
Benzimidazoles in the treatment of alveolar echinococcosis: a comparative study and review of the literature
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DOI：
10.1093/jac/46.3.451
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发表时间：
2000-09-01
影响因子：
5.2
通讯作者：
Kern, P
中科院分区：
文献类型：
--
作者：
Reuter, S;Jensen, B;Kern, P
甲苯咪唑和阿苯达唑是治疗泡型棘球蚴病的首选药物。在这项开放性观察研究中，我们介绍并评估了使用这些药物长期治疗的结果，以及不同治疗方案的效果。1992年初，35名患者开始使用甲苯咪唑或阿苯达唑进行治疗，并平均随访了39个月（范围为12 - 79个月）。如果疾病在1年以上没有进展，并且没有因副作用而需要改变治疗方案，则视为治疗成功。疾病是否进展主要通过超声和计算机断层扫描进行评估，并通过实验室检查和临床发现进一步证实。总体成功率为97%。对于泡型棘球蚴病病例，初始治疗方案在使用甲苯咪唑治疗的患者中有71%无复发，在使用阿苯达唑治疗的患者中有78%无复发。在改变治疗方案后，5例病情进展的患者中有4例病情稳定。7名患者接受了阿苯达唑持续治疗方案。对这些患者平均观察了28个月（范围为13 - 50个月），未发现病情进展迹象或明显副作用。这项开放性前瞻性研究表明，甲苯咪唑和阿苯达唑在治疗泡型棘球蚴病方面都具有较高的治疗效果，有效率相似。阿苯达唑可降低40%以上的成本，且患者更容易服用，这进一步支持了优先使用它的观点。阿苯达唑用于泡型棘球蚴病仅被批准间歇性使用。然而，持续治疗是安全的，耐受性良好，并且在其他治疗方案失败的患者中应用时显示出有希望的结果。因此，在无法手术的病例或病情进展的情况下，应强烈考虑使用这种方法。
Mebendazole and albendazole are the drugs of choice for the treatment of alveolar echinococcosis. In this open-labelled observational study we present and evaluate the outcome of long-term treatment with these drugs and present results of different treatment regimens. Thirty-five patients were started on either mebendazole or albendazole at the beginning of 1992 and followed for an average of 39 months (range 12-79 months). Treatment was classed as successful if the disease had not progressed for >1 year and if there were no side-effects necessitating a change of treatment. Lack of progression was evaluated mainly using ultrasound and computed tomography and was further substantiated by laboratory tests and clinical findings. The overall success rate was 97%. An initial regimen for cases of alveolar echinococcosis was recurrence-free in 71% of those treated with mebendazole and in 78% of those treated with albendazole. Four out of five cases with progressive disease stabilized after the therapeutic regimen was changed. Seven patients received a continuous regimen with albendazole. These patients were observed over an average of 28 months (range 13-50 months) without signs of progression or significant side-effects. This open-labelled prospective study demonstrates the high therapeutic efficacy of both mebendazole and albendazole with similar response rates in the treatment of alveolar echinococcosis. Albendazole reduced costs by >40% and is easier for patients to take, further arguing in favour of its preferred use. Albendazole in alveolar, echinococcosis is only licensed for intermittent application. None the less, continuous treatment is safe and well tolerated and showed promising results when applied to patients in whom other treatment regimens had failed. It should thus be strongly considered in inoperable cases or progressive disease.