Pharmacotherapy of helminth infection.

Background: In the first decade of the 21st century, worm infections are still very common, especially--but not exclusively--in the developing world.

Objective: To review the current pharmacotherapy of the major trematode, cestode and nematode infections of humans.

Methods: A systematic search of the Cochrane Databank of Controlled Trials and PubMed with MeSH terms (anthelmint(*) or treatment or therapy) and (cestoda or trematoda or nematoda or specific helminth species or specific medication). Further references were obtained from article biobliographies.

Results: Three hundred and twenty-six publications were selected for further review.

Conclusion: Albendazole, praziquantel and ivermectin are the most important anthelmintics available, easy to use and active against most helminths. Diethylcarbamazine is used in loasis and lymphatic filariasis. Doxycycline can eliminate endosymbiotic bacteria of certain filariae, but its place in therapy needs to be further defined. In the treatment of cystic hydatid disease, a better, non-caustic protoscolicidal drug would diminish the complication rate of current puncture-aspiration-injection-reaspiration treatment. The reliance on so few drugs creates a dangerous situation for development of resistance. Triclabendazole is a welcome addition for fascioliasis. Tribendimidine, artemisinine derivatives and nitazoxanide are promising products, but their therapeutic place needs to be further defined.