In the Journals

Some treatments for cystic echinococcosis considered medically unsound

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December 29, 2014

Significant disparities exist worldwide in the management of cystic echinococcosis, according to recent findings.

Moreover, there are aspects of cystic echinococcosis for which there is no evidence to establish treatment guidelines.

Researchers from the United Kingdom developed a questionnaire describing five clinical cases of cystic echinococcosis observed at the Hospital for Tropical Diseases in London. The case descriptions included history, examination, serological results and imaging. The survey was sent to 427 clinicians who published papers about cystic echinococcosis, those belonging to societies dedicated to cystic echinococcosis and those with clinical experience or interest in the disease. Forty-one replies were received from clinicians in 23 countries on five continents. The survey presented a series of response choices and short answer questions that asked clinicians how they would manage the cases.

Twenty-six respondents came from highly endemic countries, nine from endemic countries and two from countries with intermittent transmission. Nineteen respondents were physicians; 18 were surgeons. Respondents also included two of the three lead writers of WHO Informal Working Group on Echinococcosis (WHO-IWGE) Expert Consensus and six members of the International Association of Hydatidology.

Survey results showed substantial practice disparities in global treatment of cystic echinococcosis. Certain modalities found to be inadequate, such as PAIR (puncture, aspiration, injection and re-aspiration) procedures on WHO type 2 cysts, continue to be in widespread use. In addition, practices that are generally considered obsolete, such as interrupted courses of albendazole (Albenza, GlaxoSmithKline), also were commonly reported.

Treatments considered risky, including short-course therapy for disseminated disease and injecting scolicidal agents into cysts communicating with the biliary tree, were found to be in common practice. For unidentified reasons, most clinicians do not adhere to WHO-IWGE guidance.

According to the researchers, randomized controlled trials are needed to investigate the reasons clinicians do not follow the guidance and to establish more uniformity in cystic echinococcosis treatment practices.

“There are practices in common use that are both ineffectual and unsafe, putting patients at risk,” the researchers wrote. “Further evidence is needed to influence guidelines so that they can be more prescriptive.”

Disclosure: One of the researchers is a member of WHO-IWGE.

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