Albendazole resistance

A. Liposomal amphotericin B was approved by the US. Food and Drug Administration to treat visceral leishmaniasis. Pentavalent antimony compounds, pentamidine, amphotericin B, and aminosi-dine (paromomycin) have all been demonstrated efficacious here. The liposomal amphotericin appears to be better taken up by the reticuloendothelial system, where the parasite resides, and partitions less in the kidney, where amphotericin B traditionally manifests its toxicity. In addition to being better tolerated by patients, it has proved to be very effective in India, where resistance to antimony drugs is widespread. This patient appears to have acquired his infection there, where many infected patients develop darkening of the skin, hence the name kala-azar, or black sickness. Albendazole, an anthelmintic, has no role here. Atovaquone, a naphthoquinone, is used to treat malaria, babesiosis, and pneumocystosis. Pyrimethamine-sulfadoxine is used to treat malaria and toxoplasmosis. Proguanil inhibits the dihydrofolate reductase of malaria parasites and is used in combination with atovaquone. 

Coles, C.C. and Stafford, K.A. (2001) Activity of oxyclozanide, nitroxynil, clorsulon and albendazole against adult triclabendazole-resistant Fasciola hepatica. Veterinary Record 148, 723-724. 

Morris, D.L. and Taylor, D.H. (1 990) Echinococcus granulosus development of resistance to albendazole in an animal model, journal of Helminthology 164, 1 71-1 74. 

Nitazoxanide has been used as a single agent to treat mixed infections with intestinal parasites (protozoa and helminths) in several trials. Effective parasite clearance (based on negative follow-up fecal samples) after nitazoxanide treatment was shown for G. intestinalis, E. histolytica/E. dispar, B. hominis, C. parvum, C. cayetanensis, I. belli, H. nana, T. trichura, A. lumbricoides, and E. vermicularis, although more than one course of therapy was required in some cases. Nitazoxanide may have some efficacy against Fasciola hepatica infections, and has been used to treat infections with G. intestinalis that is resistant to metronidazole and albendazole. 

T. trichura, A. lumbricoides, and E. vermicularis, although more than one course of therapy was sometimes required. Nitazoxanide has been used to treat infections with G. intestinalis that are resistant to metronidazole and albendazole. 

Albendazole 10 mg/kg/day has been used to treat cystic echinococcosis (hydatid disease) in 11 children aged 4—14 years, with at least 10 cysts in the same organ [8 ]. The children had a total of 296 cysts located mostly in the liver (178 cysts) and the lungs (78 cysts). With exclusive albendazole therapy, 58% of pulmonary cysts, 96% of peritoneal cysts, but only 32% of hepatic cysts were cured. There were no adverse events related to treatment, apart from slight rises in serum aminotransferase activities in two cases, which normalized without withdrawal of albendazole. The high rate of viable cysts after medical therapy is problematic and in this case was attributed to poor diffusion of albendazole into the cysts, because of their multiplicity and contiguity, variable sensitivity of each cyst to albendazole, and/or insufficient duration of treatment resistance to albendazole was unlikely. 

Schwab AE, Boakye DA, Kyelem D, Prichard RK. Detection of benzimidazole resistance-associated mutations in the filarial nematode Wuch-ereria h(mcrofti and evidence for selection by albendazole and ivermectin combination treatment. Am J Trop Med Hyg 2005 73 234-8. Diawara A, Schwenkenbecher JM, Kaplan RM, Prichard RK. Molecular and biological diagnostic tests for monitoring benzimidazole resistance in human soil-transmitted helminths. Am J Trop Med Hyg 2013 88(6) 1052-61. 

Mepacrine (Fig. 25.14) can be used in resistant giardiasis. This drug was developed during the Second World War to treat malaria but has been re-introduced to treat giardiasis and is also the subject of research into the treatment of Alzheimer s disease. Albendazole may also be used as an alternative and is described below under the treatment of nematode infections. 

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