Retreatment may be necessary for lesions persisting for 6 months after the end of therapy. 2019. have suggested that a repeat dose of praziquantel, given. Bethesda, MD 20894, Copyright Introduction Praziquantel is a systemic anthelmintic used primarily to treat worm infections. 1. Theoretically, repeated treatments over time could impact survival, but the size of this effect is currently unknown. For 25 years praziquantel has been the recommended treatment for schistosomiasis, a parasite transmitted by freshwater snails in Africa, Asia and Latin America, and infecting some 200 million people worldwide. PO or SQ 1x repeat in 10 da Praziquantel 50mg per tab Equimax Paste 1cc per 100 lbs. The doses were compiled from several sources and my personal experience. Another perceived advantage to a second-dose treatment plan (not explored in our simulation) is that treatment may reach more community members by giving people a second opportunity to be treated at least once if they had missed their first dose. Our systematic review of published research found that, on average, in Africa, such repeated dosing appears to offer particular advantages in the treatment of S. mansoni, the cause of intestinal … Of note is the substantial reduction of infection levels in the 5 to 25 year age groups whether the program was limited to school age coverage (lower panel) or it used community-directed treatment of children and adults (upper panel). The following formulary is not meant to be a complete listing of all drugs available to treat reptiles nor has the information provided been proven to be safe and effective on all species of reptiles. Lower panel shows the relative efficacy for each treatment schedule for treatment of S. haematobium. Studies included in this systematic review had to involve results for both single and double praziquantel treatment for either Schistosoma mansoni or Schistosoma haematobium infection, involve population-based or sub-population (e.g., schools)-based drug treatment, and provide technical details on i) the diagnostic techniques used to define infection status, ii) the drug dosing tested, and iii) the interval for follow up. In the simulation, comparisons were made between the results for no therapy (No Rx), vs. two different treatment strategies in which residents were either offered a single-dose treatment each year, or a double-dose regimen each year. Kenya's GDP per capita was $US 1,600 in 2010 [52]. These modeling simulations were conducted using Tree-Age Pro 2009 Software (version 1.0.2, TreeAge Software, Inc. Williamstown MA). For the Markov model, relevant ranges of treatment participation and outcomes parameters used in the model (Table S1) were obtained from our systematic review. Although local infection prevalence was not a criterion for selection, all of the populations for the included studies had either moderate (>40%) or high prevalence (>50%) [23] of Schistosoma infection before therapy was given. Apply the appropriate amount of prazi to your pond. This is a simplified schematic of the full decision tree. Contact your veterinarian for guidance if a dose is missed. Total Ear Canal Ablation and Ventral Bulla Osteotomy (TECA) for End-Stage Ears in Dogs and Cats For community-wide programs the respective amounts were $45 and $433 for additional QALYs gained by single dose therapy and then the more aggressive double-dose therapy. In areas with ongoing transmission, where repeated infections and hence the presence of schistosomula in the human body is likely, repeating PZQ treatment a few weeks after the first dose might increase its overall effectiveness for para-sitological cure [12, 29]. Clipboard, Search History, and several other advanced features are temporarily unavailable. Without treatment, local residents were estimated to spend nearly 20 years with infection and 7 years with heavy infection, experiencing 2973 egg-years of infection intensity. The exact dosage of the medicine that you give to your pet will be dependent upon his weight primarily, although the severity of his condition and his other health conditions will also help to determine. Preventive chemotherapy with praziquantel (PZQ) is the cornerstone of schistosomiasis control. 8600 Rockville Pike Because while Prazi does kill worms, it doesn’t eliminate any eggs they might leave behind. 7. Affiliations Schistosomiasis remains a significant health burden for many parts of the world, particularly where health resources are most limited [1]. The ranges used for the sensitivity analysis of these parameters are, where possible, the 95% confidence interval of the original data source. Praziquantel (PZQ) is the standard treatment for Schistosomiasis in sub-Saharan Africa. Overall, the 92–99% reduction in S. haematobium intensity did not differ between the two treatment groups, while for S. mansoni, there were significant further reduction in infection intensity observed in 2/4 of the studies reporting intensity data. NCT02868385. This work received financial support from the Prof. Dr. BMC Infect Dis. The base estimate of the cost of drug delivery was $0.811 (Table S1) which reflected the financial cost per treatment without including donated volunteer time. Our projections suggest cost-effective incremental benefits from double dosing in terms of i) limiting a person's total years spent infected and ii) limiting the number of years they spend with heavy infection, with consequent improvements in quality of life. Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, United States of America, No, Is the Subject Area "Schistosoma mansoni" applicable to this article? We have included as supplemental material the full tables of our infection inputs to the decision-tree model, so that where other age-specific data are known, these could be substituted to provide a more location-specific cost-benefit analysis. Prevalence over time (with corresponding…, Fig 2. We also estimated the benefit of therapy on quality of life by summing cumulative Quality-Adjusted Life-Years, or QALYs [32], based on time spent with heavy infection, light infection or uninfected. Therefore, both single- and double- treatment methods were judged to be very cost effective as the respective ICERs were far less than $US 1,600 (1 times per-capita GDP) per QALY gained, at $17 per incremental QALY for single-dose vs. no therapy, and then $210 per incremental QALY for double-dose vs. single-dose therapy in school age treatment programs (Table 5). With minimal heterogeneity (I2 = 0) among the studies, the pooled OR of S. mansoni cure after two doses vs. one dose was 3.13, (CI95% 2.59, 3.78). In keeping with standard practice for health-related cost-effectiveness analysis, we performed analysis from the societal perspective and all future costs and utilities (QALYs) were time discounted at 3% per annum [32]. Study reports also had to provide location, study size, targeted age groups and sufficient treatment outcomes data to allow calculation of per treatment cure rates and rates for reduction of infection intensity (as measured by proportional reductions in egg output in standardized testing). For contrast, the ICER for sulfamethoxazole-trimethoprim antibiotic prophylaxis of opportunistic infections (versus no treatment) among HIV+ patients in Cote D'Ivoire has been estimated at $240 per life year gained [49]. However, our simulation of program performance in difficult-to-treat, high prevalence, high-transmission areas [6], [9], [44] indicates the maximal relative impact that a double-dose program might have in the face of ongoing transmission. Controversy persists about the optimal approach to drug-based control of schistosomiasis in high-risk communities. Repeated doses of Praziquantel in Schistosomiasis Treatment (RePST) - single versus multiple praziquantel treatments in school-aged children in Côte d'Ivoire: a study protocol for an open-label, randomised controlled trial. Prevention and treatment information (HHS). 2018 Dec 14;18(1):662. doi: 10.1186/s12879-018-3554-2. During baseline screening, 1,022 children were assessed for eligibility of whom 153 (15%) had a detectable S. mansoni infection, and hence, were randomized to the standard treatment group (N = 70) and the intense treatment group (N = 83). Based on this evidence, we used a calibrated life-path model to predict the costs and benefits of a single-dose vs. a double-dose strategy in a typical high-risk community. Yes Of note, praziquantel treatment may not be fully curative, and questions remain about the best possible timing and frequency of praziquantel dosing for optimal control of infection and morbidity. Department of Microbiology, University of Georgia, Athens, Georgia, United States of America, Affiliations Schistosomiasis. Studies have suggested that a repeat dose of praziquantel, given 2 to 8 weeks after the first dose, can improve cure rates and reduce remaining intensity of infections in population-based programs. The proportion of total variation in pooled study estimates was quite high, most likely due to genuine differences between locations. Background: The optimal timing interval of a second PZQ dose also remains uncertain. Efficacy and safety of praziquantel in preschool-aged children in an area co-endemic for Schistosoma mansoni and S. haematobium. Unable to load your collection due to an error, Unable to load your delegates due to an error. An open-label, randomized controlled trial was conducted from October 2018 to January 2019. As expected, where intensity-specific data were reported, persons with light intensity infections had higher cure rates than those with heavy infections (Table 2). As expected, the more limited programs were projected to be proportionately less expensive, but these were less effective as well. Yes In direct terms, a country like Kenya, with ∼480,000 children entering school-age in schistosomiasis-risk areas each year, would need to commit approximately $4 million in funds each year to maintain an annual single-dose program for school age therapy, and $18.4 million for single-dose community coverage. However, findings on efficacy of repeated doses in co-infection of S. mansoni and S. haematobium were not conclusive. For this phase of the analysis, cumulative time-discounted costs were summed for an average individual over the 55 year period simulated in the model, based on his or her year-to-year participation. Praziquantel Dosage Administered once at a dose of 10-20 mg/kg given orally Repeat in 10-14 days _____ Chapter 18. 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 credited. Transitions among infection states (uninfected, light, or heavy infection) from year to year were based on conditional probabilities derived from field data (see Tables S1 and S2). Schistosomiasis 2019 [Available from: Hotez PJ, Alvarado M, Basáñez MG, Bolliger I, Bourne R, Boussinesq M, et al. 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. Shown are the reasons for exclusion/inclusion at each step of the systemic review. Comments: -Doses should be separated by 4 to 6 hours. Lancet. Because of the relatively greater incremental benefit of repeated dosing for S. mansoni (Tables 2 and 3), our models estimated greater double-dose reductions in lifetime egg burden and in time spent infected for persons infected with S. mansoni when compared to those with S. haematobium (Tables 4 and 5). Rates of cure for S. haematobium infection were more varied, ranging from 37% to 93% after a single-dose treatment and from 46% to 99% after double-dose treatment (Table 2). Hypersensitivity to praziquantel or any component of the formulation; ocular cysticercosis; concomitant administration with strong cytochrome P450 (CYP450) inducers, such as rifampin. However, a single dose of PZQ (40 mg/kg) does not cure all infections. Used to treat cestode and trematode parasites. Hoekstra PT, Casacuberta Partal M, Amoah AS, van Lieshout L, Corstjens PLAM, Tsonaka S, Assaré RK, Silué KD, Meité A, N'Goran EK, N'Gbesso YK, Roestenberg M, Knopp S, Utzinger J, Coulibaly JT, van Dam GJ. U.S. Pharmacopeial Convention. In the simulation, for each coverage scenario, repeated years of double treatment were projected to provide incremental improvements over single treatment in terms of reducing the number of years spent infected, the cumulative egg-years, and in improving cumulative quality-of-life (measured as infection-related QALYs). 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. However, a single dose of PZQ (40 mg/kg) does not cure all infections. Kittur N, Castleman JD, Campbell CH, King CH, Colley DG. If you miss a dose in this sequence, your next step will largely depend on what other dewormers are present in the combination dewormer. Background: Preventive chemotherapy with praziquantel (PZQ) is the cornerstone of schistosomiasis control. It has been observed in some studies that repeated praziquantel dosing can improve the treatment-associated reductions in worm burden and also increase its overall effectiveness for parasitological cure. Here, we determined the efficacy of a single versus four repeated treatments with PZQ on Schistosoma … 2018 Dec 14;18(1):662. doi: 10.1186/s12879-018-3554-2. Repeated doses of PZQ at short intervals might increase efficacy in terms of cure rate (CR) and intensity reduction rate (IRR). Overview of the review process for papers reporting on the efficacy of praziquantel repeat dosing for treatment of S. haematobium or S. mansoni infection in Africa. Upper panel shows efficacy of one- and two-dose regimens for treatment of S. mansoni according to the initial pre-treatment infection prevalence of study participants. Epub 2016 Jan 11. Alternatively, environmental factors that favor transmission of S. mansoni (e.g., permanent water bodies vs. smaller transient ponds [42], [43]) may allow more continuous transmission, and a greater likelihood that patients will have immature larvae that will not be effectively eliminated by a single-dose annual treatment [11]. Because we anticipate a considerable loss to follow-up, we aim to include approximately 100 participants in each … Am J Trop Med Hyg. Here, the six most influential factors were quite comparable: The cost of drug delivery, the cost of drug, the estimated QALY value associated with the heavy infection state, the probability of moving from light to heavy infection after either type of therapy, and the program adherence. In anticipation of the difficulties in repeatedly targeting those who have exposure to reinfection and in having community members adhere to a multi-year treatment plan, the long-term programs should probably be a collaborative effort, with community-health care workers functioning within a community directed treatment program [45]–[47]. However, there may be an effect of double dosing that was not studied in our simulations–If double-dosing could reliably reduce local transmission, then it could exert a non-linear, or ‘tipping point’ effect in reducing the lifetime risk of reinfection, making the double-dose strategy the much more effective strategy to eliminate all forms of infection-related disease. It is unlikely that a control program would continue with a single strategy for a 55 year period of time. For example, a 1200 gallon pond requires 12 grams of praziquantel. These represented, respectively, areas with no control, areas with annual treatment with a single PZQ dose, and areas with annual treatment with repeat PZQ treatment 2–8 weeks after the initial round of treatment. For Treatment & control of parasites: Tapeworms, Roundworms, Hookworms. Schistosomiasis Consortium for Operational Research and Evaluation, University of Georgia, Athens, Georgia, United States of America, Affiliation With prazi dose once, wait about a week, do a 20-25% water change and then repeat dosage. Conceived and designed the experiments: CHK SKO MS MES JC DGC. [The interested reader can review and modify an example model from the study, which is provided in full in Model S1. here. However, a single dose of PZQ (40 mg/kg) does not cure all infections. Corresponding reductions in lifetime infectious burden are 61–67% for school age treatment and 78–92% with community therapy. Prevalence over time (with corresponding pointwise 95% confidence intervals) estimated from the mixed…, Data are based on triplicate Kato-Katz (KK) thick smears from…, National Library of Medicine Accessibility Circulating antigen tests and urine reagent strips for diagnosis of active schistosomiasis in endemic areas. WHO. Each Drontal® Plus Tablet for Medium Sized Dogs contains 68.0 mg praziquantel, 68.0 mg pyrantel base as pyrantel pamoate, and 340.2 mg febantel. Performed the experiments: CHK SKO MS MES JC DGC. Figure 6 shows a tornado diagram indicating the model parameters that were most influential in determining the double-dose/single-dose ICER for cost per egg year averted. In 2014, over 230 million individuals, including 40 million women of reproductive age, were estimated to be infected with Schistosoma haematobium, S. japonicum and/or S. mansoni.1 Despite the widespread availability of effective, praziquantel-based treatment, schistosomiasis remains the cause of substantial morbidity and mortality in many low- and middle-income countries.2 In a meta-analysis of the disability-related outcomes of endemic schistosomiasis, the disability weight assigned to schistosomiasis – whic… The study reported here is a systematic review of population-based studies that compare single- vs. repeated-dose praziquantel treatment of Schistosoma mansoni or S. haematobium in high-risk locations in Africa [12]–[21]. Praziquantel Dosage Administered once at a dose of 10-20 mg/kg given orally Repeat in 10-14 days _____ Chapter 18. 50 mg/ml Pyrantel Pamoate + 23 mg/ml Praziquantel Broad Spectrum Dewormer Oral Suspension for Cats & Dogs. No, Is the Subject Area "Computer software" applicable to this article? A repeated standard dose of 40 mg/kg achieved satisfactory efficacy compared to a single dose against both parasite species. Observed IRR was 72% (95% CI 55-83%) in the standard treatment group and 95% (95% CI 85-98%) in the intense treatment group. Results of our systematic review of treatment outcomes suggest there were significant improvements to be gained in terms of S. mansoni infection outcomes by implementing a double-dose regimen in which patients were retreated 2–8 weeks after their initial PZQ dose. Praziquantel, the antischistosomal drug was given successfully in a single oral dose. Copyright: © 2011 King et al. Figure 5 shows the model's projected S. haematobium infectious burden (egg output) at different ages for participating communities that received No Rx or single- or double-dose treatment, at an average 80% level of annual adherence to treatment. In addition, the model tracked average ‘cumulative egg years’ (cumulative egg output/year over 55 years) as individuals transitioned through heavy infection, light infection, and uninfected states during the course of their 55 annual cycles. This site needs JavaScript to work properly. a. Studies have suggested that a repeat dose of praziquantel, given 2 to 8 weeks after the first dose, can improve cure rates and reduce remaining intensity of infections in population-based programs. Yes Cure rates and egg reduction rates were low or moderate after the single dose and improved after the administration of the second dose [23, 27, 31,32,33]. Yes No, Is the Subject Area "Cost-effectiveness analysis" applicable to this article? See this image and copyright information in PMC. There is no need to bypass your biological filter. It’s also sold as Droncit or Biltricide. The studies included in our review provided retreatment at a range of 2–8 weeks after the initial PZQ dose (Table 2). PLoS Negl Trop Dis. This drug may also be given IM or IV. Cochrane Database Syst Rev. For each included study, additional information was extracted on study design (RCT or observational), location, local pre-control prevalence of schistosomiasis, and study size. Consistent with current deworming program practice, neither of our modeled PZQ strategies used individual level diagnostic testing to assign subject treatment. BMC Infect Dis. 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. Application of Praziquantel: Remove any carbon / charcoal from your pond or filter. Indications, dose, contra-indications, side-effects, interactions, cautions, warnings and other safety information for PRAZIQUANTEL. No, Is the Subject Area "Drug therapy" applicable to this article? Finally, the decision point value for the ‘willingness-to-pay’ for such a program may vary. However, we were able to use model-based simulations to estimate the long-term programmatic costs and efficacy of single and double-dose strategies in a high Schistosoma-infection transmission setting. 50 mg/kg/day PO given in 3 divided doses in combination with albendazole for 10 to 14 days in patients with more than 2 viable parenchymal lesions. Background: Preventive chemotherapy with praziquantel (PZQ) is the cornerstone of schistosomiasis control. This would be relevant if transmission is ongoing or has occurred recently, and repeated dosing might then serve to reduce infection prevalence and intensity more effectively among frequently exposed persons [11] by treating the initially immature forms after they had matured (during the treatment interval) into drug-susceptible adult worms [10]. Briefly, the model follows a cohort of residents year by year from age 5 to age 60 as they reside in a targeted treatment community and experience repeated treatments either through school age (5 to 15 yr), or throughout the entire period, in a community-wide program. 2012;6(12):e1917. The following information includes only the average doses of this medicine. Rockville, Maryland. These studies were published between 1998 and 2010, suggesting relevance to current treatment initiatives. The cost of delivery of treatment is estimated using the median financial cost of similar public health projects for mass treatment of lymphatic filariasis [31] and for community-directed treatment of onchocerciasis in Cameroon, Nigeria, and Uganda (McFarland, D, personal communication). Different projections reported for S. mansoni and S. haematobium in terms of these outcomes (Tables 4 and 5) were based on the differences observed in average drug efficacy found in our systematic review (Tables 2 and 3). Powder praziquantel is not easily water soluable and it often helps to mix your dose in a small amount of ethyl alcohol or even common vodka before dosing your tank. Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia, United States of America, If your dose is different, do not change it unless your doctor tells you to do so. safety of praziquantel has been studied in several toxicity and tolerability investiga-tions on breeding cats and kittens,1 1 a n d many years of use of this active ingredient in many countries have confirmed the favor-Repeat Dose Tolerance of a Combination of Milbemycin Oxime and Praziquantel in Breeding and Lactating Queens Rudolf Schenker, PhD1 Sulfadimethoxine (Bactrovet, Albon). Originally developed for veterinary applications, for humans it is a low cost, effective drug with mild side effects. For blood pressure control in low-income Southeast Asia, the annual cost for each disability-adjusted life year (DALY) gained by basic antihypertensive treatment are estimated at $36/year [50], which translates to $540–$900 time-discounted total cost/DALY (in that setting) for a regimen of 15–25 years of preventive drug therapy given over a person's lifetime.