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Cystic echinococcosis
mattk3 Views: 568
Published: 30 months ago
This is a reply to # 2,426,391

Cystic echinococcosis

Cystic echinococcosis

Cystic echinococcosis treatment will have side effects if Mebendazole is dosed to high levels. Usually 4 - 8 mg/kg/D is the maximum daily continuous dose for white worms (as a co-medication), side effects are minimal at these low dose levels, but will not get echinococcosis.

It appears that dosing of Albendazole and Mebendazole are done at high dose levels for echinococcosis.

I would consider discussing this with your local infectious disease, or head of the ER, to get local professional advise. If they say no, there is always a consult with the head of surgery, they are the best doctor in a hospital. If that fails, you are on your own.

When treating echinococcosis the same goes for Albendazole, typical white worm dose is 4-8mg/kg/D, done in 4 small doses of 2mg/kg/D. Again this does not apply for echinococcosis. Below, at the end of this post, there is a suggestion that they do max dose level of Albendazole, near the 8mg/kg/D level, or a bit higher. So for this infection, so dosing near the maximum continuous dosing level of Albendazole is suggested.

When dosing of antiparasitics is a high level per day, like this post suggests, one would typically divide up the dose to 4 times a day. Eat 15 minutes before meds. Crackers may help. Nausea is your foe, once you get a GI reaction, forever will you have issues. Keep nausea at bay. Chicken Broth, and other liquids in the diet will help keep the system flowing normally at these high doses.

4 doses of 10mg/kg MBZ would suffice.. When used for tape worms, the total in day dose level is40mg/kg/D, and it is needed for long periods of time, can take 2 months and 3 courses, or may take years of repeated attempts.
40 to 50 mg/kg PO once daily as an alternative. Treat for 1 to 6 months for cystic disease, and monitor for at least 2 years, monitor for alveolar disease.

Hepatic enzymes must be tested, like once per week to start.

Liver monitoring is a must at these levels, you need a hepatologist. They can test liver function.

Gentle liver detox, light nitrogen removal, and several other chemistries will need to be monitored. I usually suggest light natural Piperazine.

High Raw Vegetable diet, limited meat to 3 or 4 ounces per day, Egg per day, Yogurt, etc.

Surgery is first line treatment, with Echinococcus granulosis. Heart, Brain, Liver are all targets. In the bloodstream they are then carried to various internal organs, usually the liver and lungs. The nests are hard to have explode. Sulfur(s) Garlic, MSM, Magnesium Sulfate, Onions, Berberine sulfate etc. can be tried. B12 deficiency is common.

Liver support through oil vitamins A, D, E should be considered. 40 mg CQ10, 500mg L carnitine, and 150mg ALA may be useful daily amounts. In a liver crisis, (stool turns white or bright yellow) a few days of 2 Grams CQ10, 2 Grams L carnitine, 2 grams ALA can be taken. Choline 500 may be required, 500mg per day for 4 days. Take choline until stool color returns to normal, then discontinue, as it interferes with the meds.

These three supplements can prevent liver damage. Light use of Ginkgo 60 mg std. can be considered to maintain circulation.

Deficiency of reduced glutathione can predispose people to liver failure, 500mg per day maximum.

99mg potassium citrate a day is advisable, 133mg magnesium citrate also is helpful.

When the nest does not explode in a few months, Surgery in the liver gets more difficult. Antibodies/Biopsy are normal tests. ELISA tests of serum or cerebrospinal fluids to detect antibodies to Sparganosis are also advised. Complications with other species make medical treatment mandatory. If you have a dog, have him tested.

Pyrantel embonate, Niclosamide (Alinia) and Praziquantel also are effective.

E. multilocularis - this type is uncommon but the most virulent. E. multilocularis is resistant to Praziquantel, although high doses of Albendazole or Mebendazole is effective for this species.

Study on children, first 13 years old.

Started MBZ at 100mg/kg/D for 12 weeks, three cysts ruptured.

Blood, Immune, Liver tests were all given in the hospital.

The right lung collapsed in one child.

Penicillin was given for 10 days, at 50mg/kg, and again for 2 weeks at 100mg mg/kg for fever.

Alkaline phosphatase was monitored, (pH)

Study at 2 years was cyst free.

Done in the hospital.

Thirty nine children with 71 hydatid cysts were given Mebendazole orally in a dose of 100-200 mg/kg/day for 12 weeks and were followed up for a mean (SD) of 63 (24) months. Twenty children (three of them after a second course) were cured and another two avoided at least one operation. No serious side effects of the drug were observed.

used on a long-term basis for the treatment of human cystic and alveolar echinococcosis (also known as hydatid disease). According to the guidelines published by the World Health Organization (, long-term treatment of cystic echinococcosis using MBZ is at a dosage of 40–50 mg/kg/day for at least 3–6 months.

The poor bioavailability has long been recognized, and strategies to improve this remain actively researched, these strategies have included alternative formulations with vegetable oils [7–9], altering the crystalline structure of MBZ [10] and investigations into PEGylating [11].

Albendazole and MBZ interact with cimetidine, which inhibits metabolism and has been documented to increase MBZ plasma levels, (maximum serum levels rose to 82.3 ± 41.8 ng/ml [0.28 ± 0.14 μM ] from 55.7 ± 30.2 ng/ml [0.19 ± 0.10 μM], on 1.5 g of MBZ following chronic dosing of cimetidine at 400 mg three times a day for 30 days) [12]. This may be an important interaction with clinical relevance in that it suggests a strategy to increase bioavailability should that be required to increase the anti-cancer effect. Given that cimetidine may also have some anti-cancer activity [13], it also suggests that an investigation into possible synergies with MBZ over and above the effect on bioavailability would be an interesting avenue to explore.

While there are rare reports of reversible alopecia, urticaria, rash, gastro-intestinal upset, leukopenia, and neutropenia in some patients treated with high-dose MBZ, all adverse effects associated with other microtubule disruption agents, there do not appear to be any reports of peripheral neuropathy, which is commonly considered a classic adverse effect of microtubule disrupting agents, including the taxanes and the vinca alkaloids [27]. While this may suggest that the action of MBZ is independent of microtubule disruption, it may also be related to the fact that MBZ acts via the colchicine-binding domain, and that like colchicine, there is little effect in terms of naturopathic pain [28].

Albendazole and Mebendazole are the only anthelmintics effective against cystic echinococcosis. Albendazole is the drug of choice against this disease because its degree of systemic absorption and penetration into hydatid cysts is superior to that of Mebendazole. Albendazole in combination with percutaneous aspiration or PAIR therapy can lead to a reduction in cyst size, and, in one study, it improved efficacy over Albendazole alone against hepatic hydatid cysts. [42] When surgery cannot be avoided, presurgical use of Albendazole in echinococcus infestations reduced risk of recurrence and/or facilitated surgery by reducing intracystic pressure.

Treatment of echinococcosis for patients weighing more than 60 kg is Albendazole administered PO with meals in a dose of 400 mg twice daily for 28 days. A dose of 15 mg/kg of body weight daily in 2 divided doses (not to exceed total daily dose of 800 mg) has been suggested for patients weighing less than 60 kg. (hair will fall out at this dose level.)

For the ALB treatment of hydatid cyst disease:
Oral dosage
Adults >= 60 kg

400 mg ALB PO twice daily with meals for 28 days followed by a 14-day drug-free period. Repeat for 2 more cycles.
Adults < 60 kg

15 mg/kg/day ALB PO given in 2 divided doses (Max: 800 mg/day) for 28 days followed by a 14-day drug-free period. Repeat for 2 more cycles.

Hepatic Impairment

Patients with abnormal liver function tests prior to beginning Albendazole therapy should be carefully evaluated. In patients with evidence of extrahepatic biliary obstruction, the systemic exposure of Albendazole sulfoxide is increased and the elimination is prolonged.
Renal Impairment

The pharmacokinetics of Albendazole in patients with renal impairment have not been studied; however, renal elimination of Albendazole and Albendazole sulfoxide is negligible and dosage adjustment in renal impairment is not expected to be necessary.

KGP Flush should be used to maintain kidney function. Dropper per day in cranberry juice, no Sugar added.

Monitor liver enzymes (transaminases) and blood counts before the start of each dosing of albendazole cycle and at least every 2 weeks during treatment. If liver enzymes exceed twice the upper limit of normal, consider discontinuing therapy based on the clinical situation. When liver enzymes return to baseline, consideration may be given to restarting albendazole. If albendazole is restarted, laboratory tests should be monitored frequently.

The absolute limit of liver enzymes is 4X normal, mandatory discontinuation of antiparasitics must be performed to prevent organ damage.

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