Laboratorio de Parasitología, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas-Hospital Cayetano Heredia, Lima, Peru.
Laboratorio de Parasitología, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas-Hospital Cayetano Heredia, Lima, Peru.
J Glob Antimicrob Resist. 2021 Jun;25:264-267. doi: 10.1016/j.jgar.2021.03.023. Epub 2021 Apr 20.
Triclabendazole (TCBZ) is the recommended anthelmintic against Fasciola hepatica at a dose of 10 mg/kg body weight administered as a single or double dose. However, treatment failures to TCBZ standard-of-care (SOC) doses have been reported in humans. The aim of this study was to describe the effectiveness and tolerability of alternative TCBZ regimens in those patients who failed the SOC regimen for fascioliasis in Peru.
A retrospective study was conducted at a major referral centre for fascioliasis in Peru between 2002 and 2018. Inclusion criteria were cases with chronic F. hepatica infection who failed the SOC regimen for human fascioliasis with TCBZ at 10 mg/kg orally as single dose with food.
A total of 27 cases (59% female; mean age 39.4 years, range 6-71 years) with chronic fascioliasis failed at least once the current SOC regimen of TCBZ. Of 27 cases, 21 failed a second treatment regimen. Multiple regimens of TCBZ were given to these patients until three consecutive stool examinations were negative for Fasciola eggs. The overall cure rate was 74%. TCBZ was well tolerated with minimal side effects.
According to the results of this study, patients labelled as having 'TCBZ resistance' may respond to multiple regimens of TCBZ with a cure rate of 74%. Thus, the term 'TCBZ resistance' should be re-evaluated using biomarkers.
三氯苯达唑（TCBZ）是推荐的抗肝片吸虫药物，剂量为 10 毫克/公斤体重，单次或双剂量给药。然而，已经报道了人类对 TCBZ 标准治疗（SOC）剂量治疗失败的病例。本研究的目的是描述在秘鲁，那些对 SOC 方案治疗失败的 Fasciola 感染患者，替代 TCBZ 方案的有效性和耐受性。
这是一项在秘鲁一家主要的肝片吸虫病转诊中心进行的回顾性研究，时间为 2002 年至 2018 年。纳入标准为慢性 F. hepatica 感染病例，对 SOC 方案治疗失败，SOC 方案为 10 毫克/公斤体重口服 TCBZ，单次剂量，随餐服用。
共有 27 例（59%为女性；平均年龄 39.4 岁，范围为 6-71 岁）慢性肝片吸虫病患者至少一次 SOC 方案的 TCBZ 治疗失败。在 27 例病例中，21 例第二次治疗方案失败。对这些患者给予了多种 TCBZ 方案，直到连续三次粪便检查均未发现 Fasciola 卵。总体治愈率为 74%。TCBZ 耐受性良好，副作用极小。
根据本研究结果，被标记为“TCBZ 耐药”的患者可能对多种 TCBZ 方案有反应，治愈率为 74%。因此，应该使用生物标志物重新评估“TCBZ 耐药”这一术语。
