Efficacy of Alternating Therapy with Oxamniquine and Praziquantel to Treat Schistosoma mansoni in Children Following Failure of First Treatment

Naftale KatzCentro de Pesquisas Rene Rachou, Fiocruz, Belo Horizonte, Center for Tropical Disease, University of Lowell, Central Veterinary Laboratory, Ministry of Agriculture, Fisheries, and Food, Department of Zoology, University of Nairobi, Minas Gerais, Brazil

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Roberto S. RochaCentro de Pesquisas Rene Rachou, Fiocruz, Belo Horizonte, Center for Tropical Disease, University of Lowell, Central Veterinary Laboratory, Ministry of Agriculture, Fisheries, and Food, Department of Zoology, University of Nairobi, Minas Gerais, Brazil

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Cecilia P. de SouzaCentro de Pesquisas Rene Rachou, Fiocruz, Belo Horizonte, Center for Tropical Disease, University of Lowell, Central Veterinary Laboratory, Ministry of Agriculture, Fisheries, and Food, Department of Zoology, University of Nairobi, Minas Gerais, Brazil

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Pedro Coura FilhoCentro de Pesquisas Rene Rachou, Fiocruz, Belo Horizonte, Center for Tropical Disease, University of Lowell, Central Veterinary Laboratory, Ministry of Agriculture, Fisheries, and Food, Department of Zoology, University of Nairobi, Minas Gerais, Brazil

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John I. BruceCentro de Pesquisas Rene Rachou, Fiocruz, Belo Horizonte, Center for Tropical Disease, University of Lowell, Central Veterinary Laboratory, Ministry of Agriculture, Fisheries, and Food, Department of Zoology, University of Nairobi, Minas Gerais, Brazil

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Gerald C. ColesCentro de Pesquisas Rene Rachou, Fiocruz, Belo Horizonte, Center for Tropical Disease, University of Lowell, Central Veterinary Laboratory, Ministry of Agriculture, Fisheries, and Food, Department of Zoology, University of Nairobi, Minas Gerais, Brazil

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George K. KinotiCentro de Pesquisas Rene Rachou, Fiocruz, Belo Horizonte, Center for Tropical Disease, University of Lowell, Central Veterinary Laboratory, Ministry of Agriculture, Fisheries, and Food, Department of Zoology, University of Nairobi, Minas Gerais, Brazil

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Two hundred children infected with Schistosoma mansoni were treated with either 20 mg/kg oxamniquine or 60 mg/kg praziquantel. Cure rates (about 85%) were similar as was the percentage reduction (80%) in egg counts in uncured children. Treatment with the alternative drug of children not cured with the first treatment resulted in negative stools in 11 of 12 cases examined one month after the second round of therapy. In order to minimize the risk of the development of drug resistance, our data suggest that infected patients be treated with one drug, and therapeutic failures with another. Evidence from experiments in mice with isolates obtained after failures of one treatment in children suggests that therapeutic failure does not necessarily indicate the presence of drug-resistant schistosomes. The value of using mice to assess drug resistance in schistosomes is questioned.

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