Praziquantel resistance

Results from infected patients, not cured by multiple doses of praziquantel (PZQ), have been reported from different geographic locations, suggesting that resistance to the drug may be present. This has been coupled with several in vivo (e.g., studies on mice infected with 'resistant isolates') and in vitro tests (e.g., direct application and measurement of the effects of the drug on schistosomes maintained in culture) demonstrating a significant reduction in the drug's efficacy. Despite little field evidence that schistosomes are becoming less sensitive to the drug, 100% cure after PZQ is rarely achieved; meanwhile, the percentage of cure rates in endemic areas could be an overestimate if one accounts for the sensitivity of most egg counting methods coupled with the limited faecal sampling. To be proactive, the efficacy of PZQ has to be monitored on a systematic basis not only for cure, but also for the reduction of egg excretion complemented with periodical assessment for the susceptibility to the drug on local strains. Investigation of field isolates with confirmed diminished sensitivity to the drug will help in determining the frequency, epidemiology, genetic and physiologic basis for the observed resistance. Monitoring for changes in drug responsiveness in high transmission areas, where treatment failure as a result of immature or resistant parasites can not be differentiated, should be initiated. New chemotherapeutic alternatives and strategies in addition to a simple rapid, inexpensive test to detect resistance should be encouraged.