What are the goals of drug treatment in schistosomiasis (bilharzia), and what is the medication of choice?

Updated: Sep 20, 2018
  • Author: Shadab Hussain Ahmed, MD, AAHIVS, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

The aim of chemotherapy is 2-fold. The first goal is to cure the disease or at least minimize morbidity. The second goal is to control transmission of the parasite in the endemic areas. Praziquantel and oxamniquine (no longer available in the United States) are used commonly, but praziquantel is the treatment of choice for all species of schistosomiasis. Clinical studies show that artemether, which is used as antimalarial treatment, is also active against all 3 major schistosome parasites (mainly schistosomula). [62]

In addition, the combination of artemether and praziquantel can kill schistosomula during the first 3 weeks of infection and is synergistic with praziquantel in killing adult worms. [66] The high efficacy of mefloquine-artesunate against S haematobium warrants further investigation. Individuals co-infected with Plasmodium and Schistosoma who are treated with a mefloquine-artesunate combination against malaria may experience a dual benefit: clearance of malaria parasitemia and reduction of schistosomiasis-related morbidity. [67]


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