Volume 78, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Human fascioliasis caused by or is an increasing global problem. The mainstay of current treatment is triclabendazole, but resistance in animals has been described, and it is not available in many countries. The antimalarial artesunate has an excellent safety profile, and there is increasing evidence of its efficacy against other parasites both and . We performed a study to investigate the usefulness of artesunate in symptomatic human fascioliasis; 100 patients were enrolled. Patients treated with artesunate were significantly more likely to be free of abdominal pain at hospital discharge (50/50 versus 44/50, = 0.027, relative risk 1.14, 95% confidence interval 1.03–1.26), but the complete response rate at 3 months was lower than for patients treated with triclabendazole (38/50 versus 46/50, = 0.05, RR 0.83, 95% CI 0.69–0.98, artesunate versus triclabendazole). There may be a role for artesunate in fascioliasis.


Article metrics loading...

Loading full text...

Full text loading...



  1. Esteban JG, Gonzalez C, Curtale F, Munoz-Antoli C, Valero MA, Bargues MD, el-Sayed M, el-Wakeel AA, Abdel-Wahab Y, Montresor A, Engels D, Savioli L, Mas-Coma S, 2003. Hyperendemic fascioliasis associated with schistosomiasis in villages in the Nile Delta of Egypt. Am J Trop Med Hyg 69 : 429–437.
  2. Mas-Coma S, Bargues MD, Esteban JG, 1999. Human fasciolosis. Dalton JP, ed. Human Fasciolosis. Wallingford, United Kingdom: CAB International Publishing, 411–434.
  3. Apt W, Aguilera X, Vega F, Miranda C, Zulantay I, Perez C, Gabor M, Apt P, 1995. Treatment of human chronic fascioliasis with triclabendazole: drug efficacy and serologic response. Am J Trop Med Hyg 52 : 532–535.
  4. el-Karaksy H, Hassanein B, Okasha S, Behairy B, Gadallah I, 1999. Human fascioliasis in Egyptian children: successful treatment with triclabendazole. J Trop Pediatr 45 : 135–138.
  5. Mas-Coma S, Bargues MD, Valero MA, 2005. Fascioliasis and other plant-borne trematode zoonoses. Int J Parasitol 35 : 1255–1278.
  6. Millan JC, Mull R, Freise S, Richter J, 2000. The efficacy and tolerability of triclabendazole in Cuban patients with latent and chronic Fasciola hepatica infection. Am J Trop Med Hyg 63 : 264–269.
  7. Talaie H, Emami H, Yadegarinia D, Nava-Ocampo AA, Massoud J, Azmoudeh M, Mas-Coma S, 2004. Randomized trial of a single, double and triple dose of 10 mg/kg of a human formulation of triclabendazole in patients with fascioliasis. Clin Exp Pharmacol Physiol 31 : 777–782.
  8. Alvarez-Sanchez MA, Mainar-Jaime RC, Perez-Garcia J, Rojo-Vazquez FA, 2006. Resistance of Fasciola hepatica to triclabendazole and albendazole in sheep in Spain. Vet Rec 159 : 424–425.
  9. Gaasenbeek CP, Moll L, Cornelissen JB, Vellema P, Borgsteede FH, 2001. An experimental study on triclabendazole resistance of Fasciola hepatica in sheep. Vet Parasitol 95 : 37–43.
  10. Moll L, Gaasenbeek CP, Vellema P, Borgsteede FH, 2000. Resistance of Fasciola hepatica against triclabendazole in cattle and sheep in The Netherlands. Vet Parasitol 91 : 153–158.
  11. Overend DJ, Bowen FL, 1995. Resistance of Fasciola hepatica to triclabendazole. Aust Vet J 72 : 275–276.
  12. Favennec L, Jave Ortiz J, Gargala G, Lopez Chegne N, Ayoub A, Rossignol JF, 2003. Double-blind, randomized, placebo-controlled study of nitazoxanide in the treatment of fascioliasis in adults and children from northern Peru. Aliment Pharmacol Ther 17 : 265–270.
  13. Espinoza JR, Maco V, Marcos L, Saez S, Neyra V, Terashima A, Samalvides F, Gotuzzo E, Chavarry E, Huaman MC, Bargues MD, Valero MA, Mas-Coma S, 2007. Evaluation of Fas2-ELISA for the serological detection of Fasciola hepatica infection in humans. Am J Trop Med Hyg 76 : 977–982.
  14. Mottier L, Alvarez L, Fairweather I, Lanusse C, 2006. Resistance-induced changes in triclabendazole transport in Fasciola hepatica: ivermectin reversal effect. J Parasitol 92 : 1355–1360.
  15. Borrmann S, Szlezak N, Faucher JF, Matsiegui PB, Neubauer R, Binder RK, Lell B, Kremsner PG, 2001. Artesunate and praziquantel for the treatment of Schistosoma haematobium infections: a double-blind, randomized, placebo-controlled study. J Infect Dis 184 : 1363–1366.
  16. De Clercq D, Vercruysse J, Kongs A, Verle P, Dompnier JP, Faye PC, 2002. Efficacy of artesunate and praziquantel in Schistosoma haematobium infected schoolchildren. Acta Trop 82 : 61–66.
  17. Inyang-Etoh PC, Ejezie GC, Useh MF, Inyang-Etoh EC, 2004. Efficacy of artesunate in the treatment of urinary schistosomiasis, in an endemic community in Nigeria. Ann Trop Med Parasitol 98 : 491–499.
  18. Keiser J, Shu-Hua X, Tanner M, Utzinger J, 2006. Artesunate and artemether are effective fasciolicides in the rat model and in vitro. J Antimicrob Chemother 57 : 1139–1145.
  19. Utzinger J, Chollet J, Tu Z, Xiao S, Tanner M, 2002. Comparative study of the effects of artemether and artesunate on juvenile and adult Schistosoma mansoni in experimentally infected mice. Trans R Soc Trop Med Hyg 96 : 318–323.
  20. Dondorp A, Nosten F, Stepniewska K, Day N, White N, 2005. Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial. Lancet 366 : 717–725.
  21. Thi KDT, 2004. Serological tests for fascioliasis. Med J Ho Chi Minh City 8 : 59–67.
  22. Flohr C, Tuyen LN, Lewis S, Quinnell R, Minh TT, Liem HT, Campbell J, Pritchard D, Hien TT, Farrar J, Williams H, Britton J, 2006. Poor sanitation and helminth infection protect against skin sensitization in Vietnamese children: a cross-sectional study. J Allergy Clin Immunol 118 : 1305–1311.
  23. Curtale F, Hassanein YA, Savioli L, 2005. Control of human fascioliasis by selective chemotherapy: design, cost and effect of the first public health, school-based intervention implemented in endemic areas of the Nile Delta, Egypt. Trans R Soc Trop Med Hyg 99 : 599–609.
  24. Richter J, Freise S, Mull R, Millan JC, 1999. Fascioliasis: sonographic abnormalities of the biliary tract and evolution after treatment with triclabendazole. Trop Med Int Health 4 : 774–781.
  25. Mas-Coma MS, Esteban JG, Bargues MD, 1999. Epidemiology of human fascioliasis: a review and proposed new classification. Bull World Health Organ 77 : 340–346.
  26. Keiser J, Shu-Hua X, Jian X, Zhen-San C, Odermatt P, Tesana S, Tanner M, Utzinger J, 2006. Effect of artesunate and artemether against Clonorchis sinensis and Opisthorchis viverrini in rodent models. Int J Antimicrob Agents 28 : 370–373.

Data & Media loading...

  • Received : 04 Sep 2007
  • Accepted : 13 Dec 2007

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error