Echinococcosis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Mahshid Mir, M.D. [2] ; Cafer Zorkun, M.D., Ph.D. [3]

Overview

Both cystic echinococcosis and alveolar echinococcosis are complicated to treat, sometimes requiring extensive surgery and/or prolonged drug therapy. There are 3 options for the treatment of cystic echinococcosis: anti-infective drug treatment, percutaneous treatment of the hydatid cysts with the PAIR (Puncture, Aspiration, Injection, Re-aspiration) technique and surgery.

Medical Therapy

Cystic echinococcosis stage 1 of less than 5 cm

• Preferred regimen: Albendazole 10 to 15 mg/kg per day q12
• Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)

Cystic echinococcosis stage 1 of more than 5 cm

• Preferred regimen: Albendazole 10 to 15 mg/kg per day q12 and Puncture, Aspiration, Injection, Re-aspiration (PAIR)
• Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)

Cystic echinococcosis stage 2 of any size

• Preferred regimen: Albendazole 10 to 15 mg/kg per day q12 and either modified catheterization or surgery
• Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)

Cystic echinococcosis stage 3 of any size

• Preferred regimen: Albendazole 10 to 15 mg/kg per day q12 and either modified catheterization or surgery
• Alternative regimen: Puncture, Aspiration, Injection, Re-aspiration (PAIR)

World Health Organization classification of cystic echinococcosis and treatment stratified by cyst stage

Abbreviations: PAIR: puncture, aspiration, injection, reaspiration, CE: cystic echinococcus.

WHO stage	Description	Stage	Size	Preferred treatment	Alternate treatment
CE1	Unilocular unechoic cystic lesion with double line sign	Active	<5 cm	Albendazole alone	PAIR
			>5 cm	Albendazole + PAIR	PAIR
CE2	Multiseptated, "rosette-like" "honeycomb" cyst	Active	Any	Albendazole + either modified catheterization or surgery	Modified catheterization
CE3a	Cyst with detached membranes (water-lily sign)	Transitional	<5 cm	Albendazole alone	PAIR
			>5 cm	Albendazole + PAIR	PAIR
CE3b	Cyst with daughter cysts in solid matrix	Transitional	Any	Albendazole + either modified catheterization or surgery	Modified catheterization
CE4	Cyst with heterogenous hypoechoic/hyperechoic contents; no daughter cysts	Inactive	Any	Observation	-
CE5	Solid plus calcified wall	Inactive	Any	Observation	-