Praziquantel efficacy, urinary and intestinal schistosomiasis reinfection – a systematic review

Praziquantel (PZQ) has been extensively used as the drug of choice for the treatment of schistosomiasis on account of its safety and effectiveness against all major forms of schistosomiasis. However, low cure rate, reduced susceptibility of <i>Schistosoma mansoni</i> to PZQ and treatment failures in <i>S</i>. <i>haematobium</i> infections have been reported, raising concerns about its efficacy. Using the search terms, ‘praziquantel efficacy, schistosomiasis, school children, reinfection’ as well as defined inclusion criteria, and guided by the PRISMA guidelines, articles from 2001 to 2022 were selected from the PubMed and Google Scholar databases and reviewed to assess their importance to the research question. This review assessed the efficacy of PZQ against schistosomiasis and reinfection rates following treatment of <i>Schistosoma</i> infections in children. Majority of both intestinal and urinary schistosomiasis studies reported comparable egg reduction rates (ERRs) of 94.2% to 99.9% and 91.9% to 98%, respectively. However, ERRs suggestive of sub-optimal PZQ efficacy as well as generally high and comparable cure rates for intestinal (81.2%−99.1%) and urinary (79%−93.7%) schistosomiasis studies were reported. Schistosomiasis reinfection rates varied widely for urinary (8.1%−39.6%) and intestinal (13.9%−63.4%) studies within eight to 28 weeks following PZQ treatment. Praziquantel treatment of urinary and intestinal schistosomiasis should be accompanied by the provision of potable water, toilet, and recreational facilities to reduce reinfection and egg reduction rates and increase cure rate to expedite schistosomiasis elimination.

吡喹酮（Praziquantel，简称PZQ）因安全性良好且对所有主要类型血吸虫病（schistosomiasis）均有效，已被广泛用作血吸虫病治疗的首选药物。然而，现有研究报道了曼氏血吸虫（Schistosoma mansoni）对PZQ的易感性降低、埃及血吸虫（S. haematobium）感染治疗失败以及治愈率偏低等问题，引发学界对其疗效的担忧。本综述以"吡喹酮疗效、血吸虫病、学龄儿童、再感染"为检索词，结合明确的纳入标准，并遵循PRISMA指南，从PubMed和谷歌学术（Google Scholar）数据库中筛选2001年至2022年的相关文献，评估其与本研究主题的相关性。本次综述旨在评估PZQ对血吸虫病的疗效，以及儿童血吸虫感染治疗后的再感染率。多数肠道血吸虫病与尿路血吸虫病研究报告的虫卵减少率（egg reduction rates，简称ERRs）分别为94.2%~99.9%与91.9%~98%，二者水平相当。不过，也有研究报告显示存在提示PZQ疗效欠佳的ERRs，同时肠道血吸虫病（81.2%~99.1%）与尿路血吸虫病（79%~93.7%）的治愈率普遍较高且水平相近。在PZQ治疗后8至28周内，尿路血吸虫病研究报告的再感染率波动范围为8.1%~39.6%，肠道血吸虫病研究则为13.9%~63.4%，二者差异显著。针对肠道与尿路血吸虫病的吡喹酮治疗，应配套提供饮用水、卫生厕所及娱乐设施，以降低再感染率、提升虫卵减少率并提高治愈率，从而加快血吸虫病的消除进程。