Cargando…
Utility of Repeated Praziquantel Dosing in the Treatment of Schistosomiasis in High-Risk Communities in Africa: A Systematic Review
BACKGROUND: Controversy persists about the optimal approach to drug-based control of schistosomiasis in high-risk communities. In a systematic review of published studies, we examined evidence for incremental benefits from repeated praziquantel dosing, given 2 to 8 weeks after an initial dose, in Sc...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2011
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3176745/ https://www.ncbi.nlm.nih.gov/pubmed/21949893 http://dx.doi.org/10.1371/journal.pntd.0001321 |
_version_ | 1782212243230818304 |
---|---|
author | King, Charles H. Olbrych, Stephanie K. Soon, Margaret Singer, Mendel E. Carter, Jen Colley, Daniel G. |
author_facet | King, Charles H. Olbrych, Stephanie K. Soon, Margaret Singer, Mendel E. Carter, Jen Colley, Daniel G. |
author_sort | King, Charles H. |
collection | PubMed |
description | BACKGROUND: Controversy persists about the optimal approach to drug-based control of schistosomiasis in high-risk communities. In a systematic review of published studies, we examined evidence for incremental benefits from repeated praziquantel dosing, given 2 to 8 weeks after an initial dose, in Schistosoma-endemic areas of Africa. METHODOLOGY/PRINCIPAL FINDINGS: We performed systematic searches of electronic databases PubMed and EMBASE for relevant data using search terms ‘schistosomiasis’, ‘dosing’ and ‘praziquantel’ and hand searches of personal collections and bibliographies of recovered articles. In 10 reports meeting study criteria, improvements in parasitological treatment outcomes after two doses of praziquantel were greater for S. mansoni infection than for S. haematobium infection. Observed cure rates (positive to negative conversion in egg detection assays) were, for S. mansoni, 69–91% cure after two doses vs. 42–79% after one dose and, for S. haematobium, 46–99% cure after two doses vs. 37–93% after a single dose. Treatment benefits in terms of reduction in intensity (mean egg count) were also different for the two species—for S. mansoni, the 2-dose regimen yielded an weighted average 89% reduction in standardized egg counts compared to a 83% reduction after one dose; for S. haematobium, two doses gave a 93% reduction compared to a 94% reduction with a single dose. Cost-effectiveness analysis was performed based on Markov life path modeling. CONCLUSIONS/SIGNIFICANCE: Although schedules for repeated treatment with praziquantel require greater inputs in terms of direct costs and community participation, there are incremental benefits to this approach at an estimated cost of $153 (S. mansoni)–$211 (S. haematobium) per additional lifetime QALY gained by double treatment in school-based programs. More rapid reduction of infection-related disease may improve program adherence, and if, as an externality of the program, transmission can be reduced through more effective coverage, significant additional benefits are expected to accrue in the targeted communities. |
format | Online Article Text |
id | pubmed-3176745 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-31767452011-09-26 Utility of Repeated Praziquantel Dosing in the Treatment of Schistosomiasis in High-Risk Communities in Africa: A Systematic Review King, Charles H. Olbrych, Stephanie K. Soon, Margaret Singer, Mendel E. Carter, Jen Colley, Daniel G. PLoS Negl Trop Dis Research Article BACKGROUND: Controversy persists about the optimal approach to drug-based control of schistosomiasis in high-risk communities. In a systematic review of published studies, we examined evidence for incremental benefits from repeated praziquantel dosing, given 2 to 8 weeks after an initial dose, in Schistosoma-endemic areas of Africa. METHODOLOGY/PRINCIPAL FINDINGS: We performed systematic searches of electronic databases PubMed and EMBASE for relevant data using search terms ‘schistosomiasis’, ‘dosing’ and ‘praziquantel’ and hand searches of personal collections and bibliographies of recovered articles. In 10 reports meeting study criteria, improvements in parasitological treatment outcomes after two doses of praziquantel were greater for S. mansoni infection than for S. haematobium infection. Observed cure rates (positive to negative conversion in egg detection assays) were, for S. mansoni, 69–91% cure after two doses vs. 42–79% after one dose and, for S. haematobium, 46–99% cure after two doses vs. 37–93% after a single dose. Treatment benefits in terms of reduction in intensity (mean egg count) were also different for the two species—for S. mansoni, the 2-dose regimen yielded an weighted average 89% reduction in standardized egg counts compared to a 83% reduction after one dose; for S. haematobium, two doses gave a 93% reduction compared to a 94% reduction with a single dose. Cost-effectiveness analysis was performed based on Markov life path modeling. CONCLUSIONS/SIGNIFICANCE: Although schedules for repeated treatment with praziquantel require greater inputs in terms of direct costs and community participation, there are incremental benefits to this approach at an estimated cost of $153 (S. mansoni)–$211 (S. haematobium) per additional lifetime QALY gained by double treatment in school-based programs. More rapid reduction of infection-related disease may improve program adherence, and if, as an externality of the program, transmission can be reduced through more effective coverage, significant additional benefits are expected to accrue in the targeted communities. Public Library of Science 2011-09-20 /pmc/articles/PMC3176745/ /pubmed/21949893 http://dx.doi.org/10.1371/journal.pntd.0001321 Text en King et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article King, Charles H. Olbrych, Stephanie K. Soon, Margaret Singer, Mendel E. Carter, Jen Colley, Daniel G. Utility of Repeated Praziquantel Dosing in the Treatment of Schistosomiasis in High-Risk Communities in Africa: A Systematic Review |
title | Utility of Repeated Praziquantel Dosing in the Treatment of Schistosomiasis in High-Risk Communities in Africa: A Systematic Review |
title_full | Utility of Repeated Praziquantel Dosing in the Treatment of Schistosomiasis in High-Risk Communities in Africa: A Systematic Review |
title_fullStr | Utility of Repeated Praziquantel Dosing in the Treatment of Schistosomiasis in High-Risk Communities in Africa: A Systematic Review |
title_full_unstemmed | Utility of Repeated Praziquantel Dosing in the Treatment of Schistosomiasis in High-Risk Communities in Africa: A Systematic Review |
title_short | Utility of Repeated Praziquantel Dosing in the Treatment of Schistosomiasis in High-Risk Communities in Africa: A Systematic Review |
title_sort | utility of repeated praziquantel dosing in the treatment of schistosomiasis in high-risk communities in africa: a systematic review |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3176745/ https://www.ncbi.nlm.nih.gov/pubmed/21949893 http://dx.doi.org/10.1371/journal.pntd.0001321 |
work_keys_str_mv | AT kingcharlesh utilityofrepeatedpraziquanteldosinginthetreatmentofschistosomiasisinhighriskcommunitiesinafricaasystematicreview AT olbrychstephaniek utilityofrepeatedpraziquanteldosinginthetreatmentofschistosomiasisinhighriskcommunitiesinafricaasystematicreview AT soonmargaret utilityofrepeatedpraziquanteldosinginthetreatmentofschistosomiasisinhighriskcommunitiesinafricaasystematicreview AT singermendele utilityofrepeatedpraziquanteldosinginthetreatmentofschistosomiasisinhighriskcommunitiesinafricaasystematicreview AT carterjen utilityofrepeatedpraziquanteldosinginthetreatmentofschistosomiasisinhighriskcommunitiesinafricaasystematicreview AT colleydanielg utilityofrepeatedpraziquanteldosinginthetreatmentofschistosomiasisinhighriskcommunitiesinafricaasystematicreview |