Volume 99, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Albendazole (ABZ) is the best drug available to treat cystic echinococcosis (CE), a neglected tropical disease. Cystic echinococcosis patients often receive a continuous course of the drug for 6–12 months. In Italy, ABZ shortages occur almost on a yearly basis. We searched clinical records at the World Health Organization Collaborating Center for the Clinical Management of CE in Pavia, Italy, to estimate the amount of ABZ prescribed to patients between January 2012 and February 2017. The cost of ABZ was estimated at €2.25 per tablet based on the current market price in Italy. Patients to whom ABZ had been prescribed were contacted to determine if they had experienced difficulties in purchasing the drug and to assess how such problems affected their treatment. Of 348 identified CE patients, 127 (36.5%) were treated with ABZ for a total of 20,576 days. This led to an estimated cost of €92,592. Seventy-five patients were available for follow-up, 42 (56%) reported difficulties in obtaining ABZ. Of these patients, four (9.5%) had to search out of their region and 10 (23.8%) had to go out of the country. A total of 27 patients (64%) had to visit more than five pharmacies to locate the drug and 10 patients (23.8%) interrupted treatment because of ABZ nonavailability. Shortages in ABZ distribution can disrupt CE treatment schedules and jeopardize patient health.


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  1. Romig T, Deplazes P, Jenkins D, Giraudoux P, Massolo A, Craig PS, Wassermann M, Takahashi K, de la Rue M, , 2017. Ecology and life cycle patterns of Echinococcus species. Adv Parasitol 95: 213314. [Google Scholar]
  2. Agudelo Higuita NI, Brunetti E, McCloskey C, , 2016. Cystic echinococcosis. J Clin Microbiol 54: 518523. [Google Scholar]
  3. Budke CM, Deplazes P, Torgerson PR, , 2006. Global socioeconomic impact of cystic echinococcosis. Emerg Infect Dis 12: 296303. [Google Scholar]
  4. Torgerson PR, 2015. World Health Organization estimates of the global and regional disease burden of 11 foodborne parasitic diseases, 2010: a data synthesis. PLoS Med 12: e1001920. [Google Scholar]
  5. Brunetti E, Garcia HH, Junghanss T, , 2011. Cystic echinococcosis: chronic, complex, and still neglected. PLoS Negl Trop Dis 5: 37. [Google Scholar]
  6. WHO, 2016. Meeting of the WHO Informal Working Group on Echinococcosis (IWGE) on the Occasion of the XXIV International Congress of Hydatidology, Vol. 114, 2011–2013.
  7. Brunetti E, Kern P, Vuitton DA, , 2010. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 114: 116. [Google Scholar]
  8. Junghanss T, da Silva AM, Horton J, Chiodini PL, Brunetti E, , 2008. Clinical management of cystic echinococcosis: state of the art, problems, and perspectives. Am J Trop Med Hyg 79: 301311. [Google Scholar]
  9. Rossi P, Tamarozzi F, Galati F, Pozio E, Akhan O, Cretu CM, Vutova K, Siles-Lucas M, Brunetti E, Casulli A, HERACLES Extended Network; . 2016. The first meeting of the European register of cystic echinococcosis (ERCE). Parasit Vectors 9: 243. [Google Scholar]
  10. Filice C, Brunetti E, , 1997. Use of PAIR in human cystic echinococcosis. Acta Trop 64: 95107. [Google Scholar]
  11. Ormeci N, , 2014. PAIR vs Örmeci technique for the treatment of hydatid cyst. Turk J Gastroenterol 25: 358364. [Google Scholar]
  12. Özdil B, Keçe C, Ünalp ÖV, , 2016. An alternative method for percutaneous treatment of hydatid cysts: PAI technique. Turkiye Parazitol Derg 40: 7781. [Google Scholar]
  13. Firpo G, Vola A, Lissandrin R, Tamarozzi F, Brunetti E, , 2017. Preliminary evaluation of percutaneous treatment of echinococcal cysts without injection of scolicidal agent. Am J Trop Med Hyg 97: 18181826. [Google Scholar]
  14. Piccoli L, Tamarozzi F, Cattaneo F, Mariconti M, Filice C, Bruno A, Brunetti E, , 2014. Long-term sonographic and serological follow-up of inactive echinococcal cysts of the liver: hints for a “watch-and-wait” approach. PLoS Negl Trop Dis 8: e3057. [Google Scholar]
  15. Horton RJ, , 1997. Albendazole in treatment of human cystic echinococcosis: 12 years of experience. Acta Trop 64: 7993. [Google Scholar]
  16. Solomon N, Kachani M, Zeyhle E, Macpherson CNL, , 2017. The natural history of cystic echinococcosis in untreated and albendazole-treated patients. Acta Trop 171: 5257. [Google Scholar]
  17. Todorov T, Vutova K, Mechkov G, Georgiev P, Petkov D, Tonchev Z, Nedelkov G, , 1992. Chemotherapy of human cystic echinococcosis: comparative efficacy of mebendazole and albendazole. Ann Trop Med Parasitol 86: 5966. [Google Scholar]
  18. Hemphill A, Stadelmann B, Rufener R, Spiliotis M, Boubaker G, Müller J, Müller N, Gorgas D, Gottstein B, , 2014. Treatment of echinococcosis: albendazole and mebendazole—what else? Parasite 21: 70. [Google Scholar]
  19. Saimot AG, , 2001. Medical treatment of liver hydatidosis. World J Surg 25: 1520. [Google Scholar]
  20. Rinaldi F, De Silvestri A, Tamarozzi F, Cattaneo F, Lissandrin R, Brunetti E, , 2014. Medical treatment versus “watch and wait” in the clinical management of CE3b echinococcal cysts of the liver. BMC Infect Dis 14: 492. [Google Scholar]
  21. Stojkovic M, Zwahlen M, Teggi A, Vutova K, Cretu CM, Virdone R, Nicolaidou P, Cobanoglu N, Junghanss T, , 2009. Treatment response of cystic echinococcosis to benzimidazoles: a systematic review. PLoS Negl Trop Dis 3: e524. [Google Scholar]
  22. Franchi C, Di Vico B, Teggi A, , 1999. Long-term evaluation of patients with hydatidosis treated with benzimidazole carbamates. Clin Infect Dis 29: 304309. [Google Scholar]
  23. Nabarro LE, Amin Z, Chiodini PL, , 2015. Current management of cystic echinococcosis: a survey of specialist practice. Clin Infect Dis 60: 721728. [Google Scholar]
  24. Schipper HG, Simsek S, Van Agtmael MA, Van Lienden KP, , 2009. Case report: bone hydatid disease refractory to nitazoxanide treatment. Am J Trop Med Hyg 81: 446448. [Google Scholar]
  25. Zlitni M, Ezzaouia K, Lebib H, Karray M, Kooli M, Mestiri M, , 2001. Hydatid cyst of bone: diagnosis and treatment. World J Surg 25: 7582. [Google Scholar]
  26. AIFA. Elenco dei Medicinali Attualmente Carenti. Available at: http://www.agenziafarmaco.gov.it/content/carenze-e-indisponibiltà. Accessed January 1, 2018.
  27. WHO, 2017. Echinococcosis—Call for Participation in Advancing Echinococcosis Data Collection on Antiparasitic (Medical) Treatment. Available at: http://www.who.int/echinococcosis/Echinococcosis_Call_for_data/en/. Accessed January 8, 2018.
  28. Teggi A, Lastilla MG, De Rosa F, , 1993. Therapy of human hydatid disease with mebendazole and albendazole. Antimicrob Agents Chemother 37: 16791684. [Google Scholar]
  29. Alpern JD, Lopez-Velez R, Stauffer WM, , 2017. Access to benznidazole for Chagas disease in the United States—cautious optimism? PLoS Negl Trop Dis 11: 1014. [Google Scholar]
  30. AIFA. Banca Fati del Farmaco AIFA—Zentel. Available at: https://farmaci.agenziafarmaco.gov.it/bancadatifarmaci/farmaco?farmaco=027096.
  31. Alevizakos M, Detsis M, Grigoras CA, Machan JT, Mylonakis E, , 2016. The impact of shortages on medication prices: implications for shortage prevention. Drugs 76: 15511558. [Google Scholar]
  32. Bocquet F, Degrassat-Théas A, Peigné J, Paubel P, , 2017. The new regulatory tools of the 2016 Health Law to fight drug shortages in France. Health Policy (New York) 121: 471476. [Google Scholar]
  33. Gabrielli A, Layon NT, Bones HL, Layon AJ, , 2016. The tragedy of the commons—drug shortages and our patients’ health. Am J Med 129: 12371238. [Google Scholar]
  34. De Weerdt E, De Rijdt T, Simoens S, Casteels M, Huys I, , 2017. Time spent by Belgian hospital pharmacists on supply disruptions and drug shortages: an exploratory study. PLoS One 12: 115. [Google Scholar]
  35. Narra R, Maestri M, Budke CM, Tamarozzi F, Mariconti M, Nicoletti GJ, Rinaldi F, Brunetti E, , 2016. Costs associated with surgically treated cases of abdominal cystic echinococcosis: a single Center’s experience from 2008 to 2014, Pavia, Italy. Am J Trop Med Hyg 95: 405409. [Google Scholar]
  36. Chebli H, 2017. Human cystic echinococcosis in Morocco: ultrasound screening in the Mid Atlas through an Italian-Moroccan partnership. PLoS Negl Trop Dis 11: e0005384. [Google Scholar]
  37. Morris DL, Taylor DH, , 1988. Optimal timing of post-operative albendazole prophylaxis in E. granulosus. Ann Trop Med Parasitol 82: 6566. [Google Scholar]
  38. Lissandrin R, Agliata S, Brunetti E, , 2013. Secondary peritoneal echinococcosis causing massive bilateral hydronephrosis and renal failure. Int J Infect Dis 17: e141e142. [Google Scholar]
  39. Gavidia CM, Gonzalez AE, Barron EA, Ninaquispe B, Llamosas M, Verastegui MR, Robinson C, Gilman RH, , 2010. Evaluation of oxfendazole, praziquantel and albendazole against cystic echinococcosis: a randomized clinical trial in naturally infected sheep. PLoS Negl Trop Dis 4: e616. [Google Scholar]
  40. Gavidia CM, 2009. Evaluation of nitazoxanide and oxfendazole efficacy against cystic echinococcosis in naturally infected sheep. Am J Trop Med Hyg 80: 367372. [Google Scholar]
  41. Perez-Molina JA, Diaz-Menendez M, Gallego JI, Norman F, Monge-Maillo B, Ayala AP, Lopez-Velez R, , 2011. Evaluation of nitazoxanide for the treatment of disseminated cystic echinococcosis: report of five cases and literature review. Am J Trop Med Hyg 84: 351356. [Google Scholar]
  42. Amri M, Touil-Boukoffa C, , 2016. In vitro anti-hydatic and immunomodulatory effects of ginger and [6]-gingerol. Asian Pac J Trop Med 9: 749756. [Google Scholar]
  43. Ferretti R, Carradori S, Guglielmi P, Pierini M, Casulli A, Cirilli R, , 2017. Enantiomers of triclabendazole sulfoxide: analytical and semipreparative HPLC separation, absolute configuration assignment, and transformation into sodium salt. J Pharm Biomed Anal 140: 3844. [Google Scholar]
  44. Cirilli R, Guglielmi P, Formica FR, Casulli A, Carradori S, , 2017. The sodium salt of the enantiomers of ricobendazole: preparation, solubility and chiroptical properties. J Pharm Biomed Anal 139: 17. [Google Scholar]
  45. Tamarozzi F, Rossi P, Galati F, Mariconti M, Nicoletti GJ, Rinaldi F, Casulli A, Pozio E, Brunetti E, , 2015. The Italian registry of cystic echinococcosis (RIEC): the first prospective registry with a European future. Euro Surveill 20: 16. [Google Scholar]

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  • Received : 22 Mar 2018
  • Accepted : 29 May 2018
  • Published online : 23 Jul 2018

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