However, many of the symptoms might have been disease- rather than treatment-related, as they were already reported MLM341 before drug administration. Table 6 Treatment-related adverse events observed in patients receiving triclabendazole. Discussion While the veterinary importance of fascioliasis cannot be overemphasized, this zoonotic disease is also of considerable and growing public health importance, yet it often remains neglected. A major challenge is that treatment is restricted to a single drug, i.e., triclabendazole, which is registered for human use only in Ecuador, Egypt, France, and Venezuela [7]. Results from a study carried out in Vietnam raised some hope for an alternative; artesunate administered to patients with symptomatic fascioliasis pointed to a potential role of the artemisinins against fascioliasis.

Indeed, the authors concluded that it is worthwhile to investigate this drug class in more detail, including additional clinical trials [20]. We now present the first results with artemether in the treatment of chronic fascioliasis in two epidemiological settings of Egypt. Artemether (monotherapy) was administered following the dosing regimen of a commonly used ACT, the 6-dose regimen of artemether-lumefantrine [21], and a previously employed 3-dose malaria treatment schedule administered on a single day [22]. Egypt was selected because of the known fascioliasis endemicity, particularly in the Nile Delta, and the absence of malaria [28], [29]. The prevalence of Fasciola spp. observed in the two study sites (i.e.

, Behera and Alexandria; prevalence 3�C4%) was similar to previous studies in these areas [5], [28], [30], despite frequent community treatment programs with triclabendazole. Our study failed to extend promising findings obtained with the artemisinins in rats experimentally, and sheep naturally, infected with F. hepatica [31]. Indeed, we found low CRs (6�C35%) when artemether was given at two different malaria treatment schedules. Nonetheless, a moderate ERR of 63% was observed following the 6-dose course of artemether. The difference in the ERR between the two artemether treatment schedules (nil vs. 63%) is striking, yet difficult to explain. Since the half life of artemether is very short (<1 h) [32], parasite exposure to the drug might have been insufficient if the drug is given on a single treatment day.

However, detailed in vitro drug sensitivity and pharmacokinetic studies are required to further elucidate this issue. It is interesting to note that the CRs (nil vs. 54%) and ERRs (55% vs. 67%) were higher in patients classified GSK-3 as lightly infected compared to moderate/heavy infections in the 6-dose regimen. A similar trend was observed in a recent study, which assessed the efficacy of an artesunate-sulfalene plus pyrimethamine combination in S.