No. Only triclabendazole is effective, available from Novartis through an agreement with WHO. If you need doses for your country, contact Albis Francesco Gabrielli from WHO-Geneva, he has a ResearchGate profile.
While it's true most authorities now recommend triclabendazole exclusively in human infections, I would ask first where the patient got the disease. The reason for this is fascoliasis is a zoonotic infection in humans and if a person was infected in an area of the world where liver fluke isn't routinely treated in grazing animals, then the population of parasites probably won't be resistant to anthelminthics and would be susceptible to older medications, such as bithionol, which would then be appropriate to use.
JP Caruso, PhD, Veterinary Parasitology, University of Georgia, 1983
Here in Australia only triclabendazole is recommended. Praziquantel is ineffective for Fasciola hepatica.
The drugs used were emetine, praziquantel, and bithionol dihidroemetina, which due to its high toxicity and the long period of treatment they were relegated the historical plane to appear triclabendazole. Drug administration orally at 10 mg / kg as a single dose in a day, or sometimes may be administered at 10 mg / kg every 12 hours in a day, accompanied by a rich fatty meal to enhance absorption. The emergence of resistance to triclabendazole in various parts of the world, has caused that this imidazole be combined with artemisinin with satisfactory results even using the latter as monodrug derivatives.
This is an updated observation, for everybody's consideration:
The fact Triclabendazole resistance in liver fluke is becoming more and more widespread argues for novel compound discovery and/or novel drug combinations which don't include benzimidazoles. I say this because benzimidazole resistance to often appears fairly rapidly; in the US and Australia in the 1960s, for example, thiabendazole resistance was seen in GI nematodes within 3-4 years of its widespread use.
Instead of combining artemisinin with triclabendazole, it would be best to combine artemisinin with bithionol, praziquantel, oxaminquone and/or or other anthelminthics (e.g. Yomesan) known to be active vs. Platyhelminthes and use these for a period of time instead of benzimidazoles. This would remove liver fluke populations' resistance to benzimidazoles.
The long-term solution is to develop novel compounds and use a rotational approach, with combinations of compounds given at regular intervals and ROTATED REGULARLY, as is now done to control parasites in Racing Horses. After an interval, benzimidazoles could be reintroduced within the context of a regular rotation of anthelminthics as part of a long-term approach to liver fluke. JPCaruso, PhD, Veterinary Parasitology, University of Georgia, USA, 1983.
As others have correctly stated, Troclabendazole is the drug of choice. Lacking that, bithionol, formerly the treatment on choice, could be attempted but cure rates with this or praziquantel are not deemed dependable (the latter not recommended by US CDC). On the basis of limited data, nitazoxanide might be effective therapy in some patients. All other medications, i.e., dehydroemetine, cholorquine, or metronidazole may provide some symptomatic relief during the migratory phase only.
Emetine and the better tolerated dehydroemetine were used widely in the past and still continue to be used today, given intramuscularly or subcutaneously. However, their use was progressively abandoned due to their toxic side effects. Bithionol was the subsequent drug of choice.
Occasionaly, the patients required a second course to obtain a complete cure. The side effects
were usually mild. Metronidazole and albendazole and sporadically also mebendazole have
been also applied with more or less success. Fasciolids are the only trematodes that have
practically no response to praziquantel.
Triclabendazole is the drug of choice at present. However, triclabendazole resistance has
been described in Australia, Ireland, Scotland, the Netherlands, and Spain, also in Brazil and
Argentina. and recently also in a human highly endemic area in Peru.
Nitazoxanide may be an alternative to triclabendazole, at least for the chronic stage of
fascioliasis and for patients with low burdens.,Its usefulness for the treatment of
human cases not responding to triclabendazole is of additional value.However, a
triclabendazole-resistant patient not responding to nitazoxanide has recently been reported.
1- Rossignol JF, Abaza H, Friedman H. Successful treatment of human fascioliasis with
nitazoxanide. Trans Roy Soc Trop Med Hyg 1998;92:103-4.
2- Favennec L, Jave Ortiz J, Gargala G, Lopez Chegne N, Ayoub A. Double blind, randomized,
placebo-controlled study of nitazoxanide in the treatment of fascioliasis in adults and children
from northern Peru. Alim Pharmacol Ther 2003;17:265-70.
Emetine and the better tolerated dehydroemetine were used widely in the past and still continue to be used today, given intramuscularly or subcutaneously. However, their use was progressively abandoned due to their toxic side effects. Bithionol was the subsequent drug of choice.
Occasionaly, the patients required a second course to obtain a complete cure. The side effects
were usually mild. Metronidazole and albendazole and sporadically also mebendazole have
been also applied with more or less success. Fasciolids are the only trematodes that have
practically no response to praziquantel.
Triclabendazole is the drug of choice at present. However, triclabendazole resistance has
been described in Australia, Ireland, Scotland, the Netherlands, and Spain, also in Brazil and
Argentina. and recently also in a human highly endemic area in Peru.
Nitazoxanide may be an alternative to triclabendazole, at least for the chronic stage of
fascioliasis and for patients with low burdens.,Its usefulness for the treatment of
human cases not responding to triclabendazole is of additional value.However, a
triclabendazole-resistant patient not responding to nitazoxanide has recently been reported.
1- Rossignol JF, Abaza H, Friedman H. Successful treatment of human fascioliasis with
nitazoxanide. Trans Roy Soc Trop Med Hyg 1998;92:103-4.
2- Favennec L, Jave Ortiz J, Gargala G, Lopez Chegne N, Ayoub A. Double blind, randomized,
placebo-controlled study of nitazoxanide in the treatment of fascioliasis in adults and children
from northern Peru. Alim Pharmacol Ther 2003;17:265-70.
There is in fact, a consensus regarding the use of triclabendazole for the treatment of fasciolosis. It is an effective drug against the immature stages and the adults of both Fasciola hepatica and F. gigantica, it is well tolerated and required a single dosis (two doses in occasions). It is also the drug of choice for this matter and so far, none of the other drugs commonly used to treat helminthes have been effective or as effective as triclabendazole. I shared the concerned that has been discussed in many of the responses to this question regarding the appearance and spreading of resistant populations of the parasite to TCZ and the need for alternatives to this problem. In a recent paper, the use of nitazoxanide has been evaluated in a group of children infected with chronic fasciolosis (PLoS Negl Trop Dis.2013 Nov 21; 7(11):e2553. Fascioliasis and intestinal parasitoses affecting schoolchildren in Atlixco, Puebla State, Mexico: epidemiology and treatment with nitazoxanide). The results of the drug efficacy in this study are encouraging.
Please consider following paragraph from the site:http://www.who.int/foodborne_trematode_infections/fascioliasis/fascioliasis_diagnosis/en/
Triclabendazole, the only medicine recommended by WHO against fascioliasis, is active against both immature and adult parasites, and may therefore be employed during the acute and chronic phases. Cure rates are high , while adverse reactions following treatment are usually temporary and mild. The recommended regimen is 10 mg/kg body weight administered as a single dose in both clinical practice and preventive chemotherapy interventions. In clinical practice, where treatment failure occurs, the dosage may be increased to 20 mg/kg body weight in two divided doses 12-24 hours apart.
Control through triclabendazole
From a public health perspective, control of human fascioliasis mainly relies on timely treatment with triclabendazole, a measure that cures infected individuals and prevents development of advanced morbidity.
In areas where cases of fascioliasis occur sporadically, clinical case management of individuals reporting to their local hospital is sufficient to tackle the disease. Diagnostic protocols adapted to the socioeconomic environment of endemic areas should be adopted, and triclabendazole should be made available to peripheral health centres with the aim of increasing access to treatment.
yes,
however, the first question is, are you talking avbout a human being
2. how much triclabendazole did you give
3. in animals you can use clorsulon
let s keep in touch [email protected]
Don't forget ERCP extraction, in selected cases, unamenable to medications .
(Drug overview) Article from: Townsend Letter: The Examiner of Alternative Medicine Article date: July 1, 2006 Author: Bone, Kerry
Myrrh has been tested in uncontrolled field trials for the treatment of various parasitic infestations in sheep. In sheep naturally infected with fascioliasis, doses of 300 to 600 mg of extract were administered for one to three days. (35) A total dose of 900 to 1200 mg of extract gave a complete cure rate as assessed by stool or physical examination.
Yes Nitazoxanide is alternative to triclabendazole, and also benzimidazole derivative triclabendazole
July 5, 2018Source:Cardiff UniversitySummary:Researchers have successfully created a drug compound, from the goji berry plant, that is active against the parasites that cause schistosomiasis and fascioliasis.
Journal Reference:
Yes Nitazoxanide is alternative to triclabendazole, and also benzimidazole derivative triclabendazole
honestly, I am not convinced of Nitazoxanide. Usually Fasciola should respond to triclabendazole, may be you shozld give TCZ longer. In veterinary medicine you have clorsulon but this is not licenced for humans
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