What to know
- Praziquantel is the preferred medication for treatment of taeniasis; albendazole is another option.
- Niclosamide is an alternative for children, but not available for human use in the U.S.
- Use praziquantel and albendazole carefully in patients suspected to have cysticercosis as there are reports of seizures associated with treatment.
Treatment options
Praziquantel is the medication most often used to treat active taeniasis, given at 5-10 mg/kg orally once for adults and 5-10 mg/kg orally once for children. Available evidence suggests that using 10mg/kg once orally may have a higher rate of cure than the 5mg/kg dose. Niclosamide is an alternative, given at 2 g orally once for adults and 50 mg/kg orally once for children. Albendazole, given as 400mg daily for three days, may be used as another option for the treatment of taeniasis, although this is based on studies treating small numbers of infected individuals with T. solium or T. saginata. Stools may be collected for 3 days after treatment to search for proglottids or scolices for species identification if necessary. Stools should be re-examined for Taenia eggs 1 and 3 months after treatment to be sure the infection is cleared.
Both praziquantel and albendazole should be used cautiously in patients suspected to have cysticercosis. There are case reports of seizures that may have been temporally associated with treatment.
Oral praziquantel is available for human use in the United States.
Niclosamide is NOT available for human use in the United States.
Oral albendazole is available for human use in the United States.
Praziquantel and albendazole are not approved by the U.S. Food and Drug Administration for the treatment of taeniasis.
Care precautions
Treatment in Pregnancy
Praziquantel is a pregnancy category B drug. There are no adequate and well-controlled studies in pregnant women. However, the available evidence suggests no difference in adverse birth outcomes in the children of women who were accidentally treated with praziquantel during mass drug administration (MDA) campaigns compared with those who were not. In MDA campaigns for which the World Health Organization (WHO) has determined that the benefit of treatment outweighs the risk, WHO encourages the use of praziquantel in any stage of pregnancy. For individual patients in clinical settings, healthcare providers should consider the risk of treatment in infected pregnant women with the risk of disease progression in the absence of treatment.
Pregnancy Category B: Either animal-reproduction studies have not demonstrated a fetal risk plus there are no controlled studies in pregnant women, or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no evidence of a risk in later trimesters).
Treatment during lactation
Praziquantel is excreted in low concentrations in breast milk. According to WHO guidelines for MDA campaigns, the use of praziquantel during lactation is encouraged. For individual patients in clinical settings, healthcare providers should consider the risk of treatment in infected breastfeeding women with the risk of disease progression in the absence of treatment.
Treatment in pediatric patients
The safety of praziquantel in children aged less than 4 years has not been established. WHO now recommends treating children at least 2 years of age with praziquantel during MDA campaigns for schistosomiasis control, citing evidence that praziquantel is safe in this age group. For individual patients in clinical settings, healthcare providers should consider the risk of treatment in children younger than 4 years old with the risk of disease progression in the absence of treatment.
Treatment in pregnancy
Niclosamide is a pregnancy category B drug. Data on the use of niclosamide in pregnant women are limited. Niclosamide is minimally absorbed from the gastrointestinal tract. Healthcare providers should consider the risk of treatment in infected pregnant women with the potential risk to the fetus in the absence of treatment.
Pregnancy Category B: Either animal-reproduction studies have not demonstrated a fetal risk plus there are no controlled studies in pregnant women, or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no evidence of a risk in later trimesters).
Treatment during lactation
It is not known whether niclosamide is excreted in breast milk, although niclosamide is minimally absorbed from the gastrointestinal tract. The World Health Organization (WHO) classifies niclosamide as compatible with breastfeeding, although there are limited data on the use of niclosamide during lactation.
Treatment in pediatric patients
The safety of niclosamide in children has not been established, although niclosamide is minimally absorbed from the gastrointestinal tract. Available evidence suggests that the safety profiles are comparable in children 2 years or older and adults.
Treatment in pregnancy
Albendazole is a pregnancy category C drug. There are limited data on the use of albendazole in pregnant women. The available evidence suggests no difference in congenital abnormalities in the children of women accidentally treated with albendazole during mass drug administration (MDA) campaigns compared with those who were not. In MDA campaigns for which the World Health Organization (WHO) has determined that the benefits of treatment outweigh the risks, WHO allows use of albendazole in the 2nd and 3rd trimesters of pregnancy. However, healthcare providers should balance the risks of treatment for the fetus with the risks of disease progression in the woman in the absence of treatment.
Pregnancy Category C: Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal, or other) plus there are no controlled studies in women, or studies in women and animals are not available. Prescribe albendazole only if the potential benefits to the woman justify the potential risks to the fetus.
Treatment during lactation
Albendazole is minimally excreted in human milk. WHO has concluded that a single oral dose of albendazole can be given to lactating women.
Treatment in pediatric patients
The safety of albendazole in children less than 6 years old is not certain. Studies of the use of albendazole in children as young as one year old suggest that it is safe. According to WHO guidelines for MDA campaigns, children as young as one year of age (able to safely swallow tablets) can take albendazole. These campaigns have treated many children under six years old with albendazole, albeit at a reduced dose.