Pracyquantele: recognized anti-parasitic applications, clinical evidence and new directions in research

Prazykwantel, introduced into medicine in the 1970s, has become one of the basic drugs used in the fight against schistosomiasis and the treatment of several other infections caused by parasitic worms. It exhibits activity against the major species of the genus Priapulavirus. Schistosoma infecting people, including Schistosoma haematobium, S. mansoni, S. japonicum, S. mekongi i S. intercalatum. These parasites can attack the urinary system, the intestines, and the liver, and the clinical picture of infection varies depending on the species and geographical region. Prazykwantel is used both in the treatment of recognized infections and in population-based programs to combat schistosomiasis in endemic areas [1].

Its spectrum of action also includes other parasites and tapeworms, including the liver tapeworm Clonorchis sinensis and species from the genus Opisthorchis, with pleura from the genus Paragonimus and tapeworms, such as species from the genus Taenia. Treatment in a bulwark is more complex, and praziquantel is being studied as a complementary treatment rather than as a universal standalone therapy. The appropriate treatment regimen depends on the type of parasite, the location of the disease, and the clinical situation.

Chemical structure: Pracyquantel in the PubChem database.

Prasugrel acts rapidly on susceptible adult parasites, damaging their outer shell, called the tegument, and causing muscle dysfunction and paralysis. Its activity against immature forms of schistosomes is less predictable, and the drug does not directly eliminate the complex eggs. Therefore, continuous exposure to infection and re-infection remain significant challenges for disease control programs. In clinical and public health studies, body weight-based regimens are often analyzed, including 40 mg/kg in schistosomiasis. However, study protocols should not be treated as individual prescribing recommendations [1].

Evidence from research on schistosomiasis

Comparisons with other drugs and associated regimens

In a randomized exploratory study conducted on the Ivory Coast, 61 children aged 7–15 years infected with HIV participated. S. haematobium. Keiser and colleagues compared pramipexole alone with regimens comprising mefloquine, used alone or in combination with artesunate. In all groups, the number of parasite eggs decreased by more than 94%. Adding the remaining drugs did not significantly improve the percentage of cures, but was associated with additional adverse effects such as dizziness and abdominal discomfort. In this study, pramipexole used alone provided a favorable balance between efficacy and tolerability [2].

In Uganda, Sousa-Figueiredo and colleagues studied 369 infants and children aged five months to seven years who were infected. S. mansoni. After treatment, the percentage of cures assessed after three to four weeks was 56.4%. In children who had not previously received pramipexole, this percentage was higher than in children previously treated: 77.6% compared to 41.7%. A higher incidence of infection was associated with slightly worse results, although the number of parasite eggs continued to decline significantly. Reported adverse reactions were generally mild and transient [3].

The POPVAC A study evaluated whether more intensive administration of prasyquanquate affects the post-vaccination response in Ugandan students aged 9–17 years. Repeat treatment reduced the level of parasitic infections, but the immunological results differed depending on the vaccine. The researchers observed a stronger response to the BCG vaccine, while antibody responses after HPV vaccination were weaker. These results indicate the need for further research, but they do not prove that prasyquanquate routinely improves or weakens the post-vaccination protection [4].

In a Phase III study conducted in Ivory Coast and Kenya, arprazyquante, a formulation of the drug that breaks down in the oral cavity and is designed for younger children, was evaluated. Among 288 participants aged three months to six years, the cure rate was 87.8% for arprazyquante and 81.3% for traditional praziquantel. The formulation was designed to facilitate the administration of the drug to young children. Gastrointestinal adverse reactions were generally mild. The results support the continued use and evaluation of age-appropriate formulations in schistosomiasis control programs [5].

Population treatment, age and severity of infection

In a field study in Ethiopia, 341 residents of the village of Dulshatalo were evaluated; approximately 58% of them were found to be infected. S. haematobium. After treatment with prazyquante, researchers observed 86% cures and a reduction in the number of parasite eggs by 85%. Transient nausea and abdominal discomfort occurred, but the intervention was generally well tolerated [6].

Coulibaly and colleagues compared increasing pramipexole doses in children aged two to five and from six to fifteen years on the Ivory Coast. Among preschool children with mild infection, the lowest dose tested was associated with 86% cures, while school-aged children responded particularly well to the conventional regimen. In all groups studied, the reduction in egg count remained at around 97–99% levels. The results suggested that increasing the dose did not always lead to proportionally better results in this population [7].

In a randomized trial in Kenya involving 426 children, Obonyo and colleagues compared pralidoxime alone with the combination of artesunate and sulfanilamide with pirimetamine. In infections S. mansoni The cure rates were 75.6% with the prasyquante alone and 77.8% with the combined treatment, and the number of eggs decreased by 80.1% and 88.4%, respectively. In the case of S. haematobium The cure rates were 81.4% and 82.2%, while the reduction in the number of eggs reached 95.6% and 97.7%, respectively. The differences were relatively small, and the study itself does not prove that the combined treatment prevents the development of resistance [8].

In another study involving 639 infected children S. mansoni Pracyquental was analyzed, after which dihydroartemisinin with piperazine was used. After three weeks, the percentage of cures was 88.3% in the combination treatment group and 81.2% with pracyquental alone. After eight weeks, these values were 81.9% and 63.9%, respectively, and the reduction in egg counts reached 93.6% and 87.9%, respectively. Among the reported mild side effects, abdominal pain was observed. The results indicate that when interpreting the combination strategy, the length of observation, reinfection, and local transmission of parasites must be taken into account [9].

A study on community-level treatment reported a decrease in the frequency of infections S. mansoni In untreated preschool children aged 21% to 6% after the distribution of pramipexole among older children, liver-related indicators also improved, and the proportion of favorable results increased from 57.8% to 70.3%. This pattern is consistent with the possibility of indirect benefits resulting from reducing the pressure of infections. However, these results should not be taken as evidence of a complete interruption of transmission [10].

In Zimbabwe, Wami and colleagues evaluated preschool children and primary school students for urinary tract schistosomiasis. The overall cure rate after 12 weeks was 94.6%. Urine parameters also improved: proteinuria decreased by approximately half, albuminuria occurred much less frequently, and microscopic hematuria decreased during longer follow-up. The results suggest that treatment of the infection may limit the measurable consequences of the disease in the urinary tract in both age groups [11].

In a small study in Tanzania, nine women with female genital schistosomiasis were observed. In all of them, parazitological cure was achieved, and symptoms such as painful urination and discomfort in the genital area were alleviated. Some of the visible pathological changes subsided, but others persisted, especially when the clinical picture was complicated by fibrosis or concomitant HPV infection. Therefore, parasite elimination does not guarantee the regression of already existing tissue damage [12].

Stephenson and colleagues compared pramipexole, metrifonate and placebo in 312 Kenyan children infected with the virus. S. haematobium. After eight months, 13% children in the praziquantel group still excreted the parasite eggs, compared with 62% in the metrifonate group. Unlike metrifonate, praziquantel did not reduce the infection with hookworms. The study shows why anemia and other health consequences in endemic regions must be interpreted in the context of multiple simultaneous infections [13].

Research going beyond the elimination of parasites

Markers of cervical resistance and susceptibility to HIV

Yegorov and his colleagues analyzed the responses of the cervical immune cells after treatment of infected women. S. mansoni. In laboratory studies, reduced HIV entry into CD4+ T lymphocytes from the cervix was observed. This was accompanied by an increase in interferon alpha-related activity and changes in the viral-inhibiting gene expression pathways. Some of the changes persisted for more than two months. The results concern biological markers of susceptibility to infection. The study showed that prazyquante did not prevent HIV infections in real populations [14].

Cognitive functions in infected children

Nokes and colleagues studied Chinese primary school students infected with the virus. S. japonicum. After anti-parasitic treatment, younger children, especially those aged five to seven, showed improvement in some memory and language tasks after three months. The changes were particularly noticeable in children with malnutrition, iron deficiency, or more severe infections. In older children, the improvement was less pronounced. The results should best be interpreted as possible benefits resulting from the treatment of a parasitic disease, rather than as evidence that praziquantel directly improves cognitive functions in uninfected children [15].

Liver fibrosis and other health indicators

In a three-year study involving 60 patients with chronic liver damage associated with schistosomiasis, 93% people in the treatment group showed improvement compared to 60% in the control group. The intervention included periodic treatment with praziquantel, and the authors described improvements in liver function parameters and fibrosis markers. The results suggest that limiting persistent parasitic infection may support regeneration. However, the extent of regression of existing fibrosis depends on the stage of the disease and other factors [16].

In Kenyan school-age boys with severe infection S. haematobium Latham and colleagues observed a 99.9% reduction in the number of parasite eggs within five weeks of treatment with praziquantel. This was accompanied by an improvement in appetite and physical performance. Metrifonate also improved some parameters and showed activity against nematodes. The results highlight the broad impact of parasitic infections on the functioning of the organism, rather than the independent effect of praziquantel enhancing physical performance [17].

Praziquantel in infections of the biliary tract

Choi and colleagues evaluated the extended-release formulation in healthy volunteers and infected individuals. Clonorchis sinensis. The formulation provided more gradual exposure to the drug. In the infected participants, one of the tested regimens resulted in 60% cures and reduced the number of eggs by more than 95% after three weeks. Although the results were more favorable than with the conventional single-dose regimen, they did not match the effectiveness of some multiple-dose regimens. This was an experimental formulation study, not evidence of its universal superiority [18].

In a randomized study in Laos, prasyquentan was compared with tribendimidine in infections. Opisthorchis viverrini. In the praquantic acid group, 97.3% cures and a 99.9% reduction in egg count were observed compared to 93.6% cures with tribendimidin. Among the transient adverse effects, headaches and nausea occurred. The results confirm the activity of praquantic acid against this liver-related condition under the study conditions [19].

In another study in Laos, 125 students received one of several anti-parasitic drugs. Pracyquental allowed 56% infections to be cured. O. viverrini And they reduced the number of eggs by more than 98%. The regimens based on mefloquine and artesunate were less effective, while with tribendimidine 70% cases of cure were reported. The differences between the studies and the severity of infections make it difficult to directly compare the results obtained in different populations [20].

Lovis and his colleagues studied children who were simultaneously infected. O. viverrini i S. mekongi. The larger, divided into several batches, praquanticel schemat yielded 96.6% infections cured. O. viverrini, Compared to the 71.4% with the smaller single-dose regimen. Both approaches reduced the number of eggs by more than 99%, and the treatment results were excellent. S. mekongi The symptoms were similar. In both groups, short-term abdominal discomfort, headaches, and dizziness were reported [21].

In a study comparing different doses, involving 217 adults with a mild infection O. viverrini, High cure rates were observed in all analyzed regimens, ranging from approximately 92.7–95.5%. The number of eggs decreased by more than 99.5%. In this study, smaller single-dose regimens were associated with fewer reported adverse reactions. However, these results pertain to a specific severity of infection and should not be generalized to all hepatic fluke infections [22].

In an earlier study in Thailand, involving 96 people with severe infection O. viverrini, In 97% participants evaluated during the control observation, no parasite eggs were detected after treatment. Almost 90% reported short-term symptoms such as nausea or dizziness. The high frequency of transient adverse reactions is an important context for interpreting the reported parasiteological response [23].

Research on intestinal parasite infections

Chen and his colleagues compared prasyquental with a salt containing mebendazol the infection. Echinochasmus fujianensis in south-eastern China. A larger regimen of praziquantel provided 100% cures, and a smaller one 92.3%. In the comparison groups, the cure rates were 85.2% and 71.4%, respectively. Gastrointestinal symptoms generally subsided, and adverse reactions were described as transient. The results refer to the examined parasite and protocols, not to a universal regimen for all intestinal diseases [24].

In a Thai study involving 95 infected adults Opisthorchis, Haplorchis The products containing prazyquante from various manufacturers were compared with related parasites. During the 30-day evaluation period, all participants experienced clearance, and the adverse reactions were mostly mild and transient. This result supports the comparability of the results for the studied products, but does not replace the assessment of the quality of other formulations unrelated to the study [25].

Bunnag and colleagues evaluated three patterns of praquiquantel in 85 infected children Fasciolopsis buski. In all three groups, elimination of infection was confirmed during the described observation. However, larger regimens were associated with more frequent nausea, headaches, abdominal discomfort, and fatigue. The study shows that treatment tolerance may be an important factor when different regimens provide similar measured efficacy [26].

Experimental local applications

Two pilot studies evaluated a cream containing 3% prasyquentan in inflammatory skin diseases. In a study of rosacea involving 65 adults, the use of the topical formulation was associated with improvements in redness and quality of life indicators within 16 weeks compared to a cream without the active ingredient. Laboratory studies also suggested antimicrobial activity, although this does not confirm the mechanism of clinical improvement [27].

In a separate randomized, placebo-controlled pilot study, 46 adults with oral mucositis were included. Participants using topical prasyquentan reported improvement within a few weeks, and the source material did not describe any serious adverse reactions associated with the treatment. Both studies were relatively small. They justify further research, but do not allow topical prasyquentan to be considered a definitive first-line treatment method in any of these diseases [28].

Infections of the pleura of the lungs

Udonsi studied 332 infected patients in Nigeria. Paragonimus uterobilateralis. The cure rates increased in the three analyzed regimens: from approximately 71% to 85%, and then to almost 98%. With the largest regimen, the number of eggs decreased by more than 90%. Among participants aged 15–29 years, the study showed complete cure at this exposure level. The results show a dose-response relationship in this historical field study, but do not replace contemporary, individual clinical recommendations [29].

Tapeworm infections and neurocysticercosis

Brain bags and results regarding epileptic seizures

In a small pilot study, 16 people with epilepsy associated with neurocysticercosis were observed; their seizures persisted despite the use of anti-seizure medications. After treatment with albendazole or praziquantel, no further seizures occurred in 13 participants during the observation period, and in two only one seizure occurred. Imaging studies showed the disappearance of seizures in many participants. Since various anti-parasitic drugs were used and the trial was small, the effect of praziquantel alone on preventing seizures cannot be determined [30].

Garcia and colleagues studied 32 patients with live cysts in the brain parenchyma, comparing albendazole alone with a combination of albendazole and praziquantel. The combination treatment resulted in the disappearance of 95% cysts, compared with 30% in the group receiving albendazole alone. Complete removal of the cysts was observed in 75% and 25% patients, respectively. The participants also received supportive treatment, including corticosteroids and antiepileptic drugs. The results support the value of the combination treatment in a specific form of neurocysticercosis studied [31].

In a related pharmacokinetic study, it was shown that the simultaneous administration of prasugrel increased the exposure to the active metabolite of albendazole. This interaction may partially explain the efficacy of the combination, but the safety of the treatment and interactions still require evaluation in each clinical situation [32].

In a randomized pediatric study regarding persistent neurocysticercosis, the resolution of lesions was observed in 62% children receiving albendazole with praziquantel, in 26.3% children receiving albendazole alone, and in no participant from the placebo group. In this trial, researchers did not report any additional signal of serious adverse events or seizures. The results should be interpreted in the context of specific eligibility criteria and the observation period [33].

Proaño and colleagues observed for a long time 33 people with giant intracranial tumors. The participants received albendazole and steroids, and ten additional patients received praziquantel. Across the group, improvements in clinical and imaging outcomes were observed, including functional capacity and seizure control. Since praziquantel was only given to a portion of the participants and the treatment strategy did not provide a straightforward direct comparison, the improvements cannot be attributed solely to this drug [34].

Pretell and colleagues studied 26 patients with a single brain lesion showing contrast enhancement. Among the 14 receiving pracyquante, 79% experienced a resolution of the lesion. The results were compared with a control group of 12 patients. The small sample size limits the ability to draw conclusions about the best treatment strategy for all cases of single brain lesions [35].

In a separate study involving 100 adults with cerebral cysticercosis, Cruz and colleagues compared albendazole with praziquantel while concurrently using corticosteroids. In both groups, clinical and electrophysiological parameters improved, although albendazole was associated with slightly greater regression of the lesions. The results highlight the importance of the type of lesions, concomitant anti-inflammatory treatment, and monitoring during the evaluation of the results of neurocysticercosis therapy [36].

Scarlet fever infection

In a study of Peruvian children aged one to eleven years, pracyquentan was compared with nitazoxanide in infection. Hymenolepis nana. The cure rates were 96% and 82%, respectively, with a significant reduction in the number of eggs in the feces. No adverse effects were reported in the original summary. The study confirms the efficacy of praquiquantel against this intestinal tapeworm in the conditions analyzed [37].

Experimental anti-cancer research

Wu and colleagues investigated whether prazyquante could enhance the activity of paclitaxel in cancer models. In human tumor cell cultures, the combination of both compounds inhibited cell growth more strongly and accelerated their death than either compound used alone. The researchers identified changes associated with XIAP, a protein that helps cells avoid apoptosis, and observed stronger inhibition of tumor growth in mice receiving both compounds. These were preclinical studies. They do not show that prazyquante improves chemotherapy outcomes or overcomes treatment resistance in patients [38].

Studies of combined therapy in giardiasis and botulism

Pengsaa and colleagues studied 84 infected children. Giardia intestinalis. The combination of albendazole with praziquantel provided 74.2% cures, compared to 50% with albendazole alone and 92.6% with tinidazole. The combination treatment was more effective than albendazole alone, but did not surpass tinidazole. Mild gastrointestinal side effects were described. This small study should not be interpreted as confirmation that praziquantel is a standard standalone treatment for giardiasis [39].

Pérez-Molina and colleagues described the experience of treating difficult cases of disseminated cystic echinococcosis using combinations of nitazoxanide and albendazole, and in some cases also praziquantel. In some patients, improvement was observed, including regression of the echinococcosis in the soft tissues, while bone changes could persist. The diverse combinations of drugs and the small number of cases do not allow independent determination of the role of praziquantel in the obtained results [40].

Safety studies of combined vaccination programs

Namwanje and colleagues evaluated the simultaneous use of albendazole, ivermectin, and praziquantel in 235 Ugandan students with multiple parasitic infections. In the study, the combination was comparable to a treatment administered over time and was not associated with serious adverse effects. Some participants experienced transient headaches and gastrointestinal symptoms, while measured liver function parameters remained stable [41].

In a randomized cross-over study involving 23 healthy volunteers from Thailand, Na-Bangchang and colleagues compared pramipexole alone, a combination of albendazole with ivermectin, and a combination of all three drugs. Mild adverse reactions were reported with 52% exposures to pramipexole alone, 30% exposures to the combination of three drugs, and no adverse reactions were reported with the albendazole-ivermectin combination. The pharmacokinetic changes were relatively minor in this small study. The results provide information for drug interaction studies, but do not guarantee safety in every population or in all co-morbid conditions [42].

The program in Zanzibar began with safety monitoring of 5,055 participants, and was subsequently expanded to more than 700,000 people under an integrated therapeutic approach. Reported adverse events were generally mild and short-lived, and no serious or persistent reactions were identified in the program monitoring report included in the source material. The implementation of large-scale programs still requires continuous supervision, assessment of participants’ qualifications, and compliance with local public health protocols [43].

Pregnancy, breastfeeding and children's health

Researchers studied both the effectiveness of pramipexole in mothers and the possible consequences of treatment during pregnancy. In a Philippine cohort study, children whose mothers were treated for an infection were observed. S. japonicum. At the age of six, they were not found to be at increased risk of infection, although some measurements of immune response differed between groups [44]. In the Ugandan study, limited overall health benefits were noted in some outcomes related to mothers and infants, and a small signal related to eczema in some subgroups of offspring. These observations require cautious interpretation and do not demonstrate a general causal relationship between prazykwantele and eczema in children [45].

In Gabon, in a controlled study, pregnant women infected with HIV S. haematobium A reduction in infection rates of approximately 95% was noted and improvements in some parameters related to anemia were observed. Adverse effects were mostly mild [46]. In Uganda, the immune responses of mothers and their children after treatment for infection were also analyzed. S. mansoni. Parasitological results in mothers improved, without clear evidence of harmful effects on newborns in the evaluated endpoints [47].

Pharmacokinetic studies conducted in Filipinas showed that the clearance of pramipexole differed depending on the stage of pregnancy. Elimination of the drug was faster in the earlier period of pregnancy, whereas in later pregnancy and during lactation the exposure profiles were more comparable. Breast milk exposure was determined to be low. These measurements help characterize exposure, but in themselves do not prove the absence of any risk to infants [48].

In a five-year observation period involving more than 1,300 children, no significant difference was found in the frequency of infections. S. mansoni Depending on whether their mothers received prasugrel during pregnancy. However, some immune markers, including IL-10, differed between groups [49]. In a separate study, essentially similar efficacy of treatment was demonstrated for mothers during pregnancy and after delivery, despite differences in measured antibody responses [50].

Friedman and colleagues reviewed studies from Uganda and the Philippines. In the populations analyzed, they did not find any signal indicating a deterioration in pregnancy or childbirth outcomes due to the use of praziquantel. These results form the basis for public health recommendations that pregnant and breastfeeding women should not be automatically excluded from schistosomiasis treatment programs. Decisions in individual cases still depend on clinical assessment and applicable guidelines [51].

Pediatric formulations: syrup and crushed tablets

Navaratnam and colleagues compared syrup containing prazyquante with crushed tablets in 1144 Ugandan children under the age of five. After three weeks, the cure rates were 80.9% for the syrup and 81.7% for the crushed tablets, and the number of eggs decreased by 86.1% and 89.0%, respectively. More severe infections were associated with slightly lower efficacy, while both formulations showed favorable short-term tolerability. The results highlight the importance of the practical forms of the drug in preschool child treatment programs [52].

Clinically significant drug interaction: rifampicin

Ridtitid and colleagues studied the interaction between prazyquante and rifampicin in ten healthy volunteers. After exposure to rifampicin, the maximum concentration of prazyquante and total systemic exposure decreased by approximately 74–99%, and drug concentrations sometimes fell below the detection limit. The interaction is consistent with strong induction of drug metabolizing enzymes by rifampicin, including CYP3A. Such a significant reduction in exposure can be of significant clinical significance and requires professional drug therapy assessment, especially in regions where tuberculosis and schistosomiasis occur simultaneously [53].

Preparations used in humans and interpretation of dosage studies

Biltricide is a brand drug containing pramipexole, associated with the Bayer company and used to treat parasitic infections in humans. The approved indications, the prescription status of the drug, and the instructions for use vary depending on the country. It is necessary to check them based on the current local product documentation.

The studies discussed analyzed various regimens based on body weight, as different parasite species, the severity of infections, the age of the participants, the formulations, and the location of the disease changes varied. For example, in the studies of schistosomiasis, 40 mg/kg was often evaluated; in some pediatric studies, smaller or larger regimens were analyzed, while in infections with hepatic trematodes and neurocysticercosis, split dosing or combination therapy was sometimes used. These numbers describe the study protocols, not the overall dosage table. Treatment of brain abscesses, infections during pregnancy, or complex co-infections requires specialized evaluation and monitoring. Similarly, the topical formulation 3% studied in rosacea and inflammation around the mouth represents a separate research direction, distinct from recognized oral anti-parasitic uses.

Summary

Praziquantel remains one of the most important drugs used in the fight against schistosomiasis and the treatment of many infections caused by schistosomes and tapeworms. Studies conducted in communities in endemic areas document a reduction in parasite burdens and, under some conditions, an improvement in urinary system parameters, liver function, nutritional status, and functional capacity after treatment of the infection. Research into pediatric formulations and integrated public health programs continue to help refine treatment strategies.

At the same time, results that go beyond recognized indications against parasites require a clear distinction. The changes observed in laboratory tests of HIV penetration into the cervical cells do not indicate prevention of HIV infection. The improvement in children’s school performance after parasite treatment does not mean that praziquantel is a means to improve cognitive functions. Meanwhile, the laboratory synergy with paclitaxel does not confirm the effectiveness of anti-cancer treatment. Small dermatological studies and selected combination regimens remain research directions, rather than widely confirmed indications.

The most plausible interpretation of the evidence therefore includes two conclusions: prazykwantel has a well-established role in the treatment of parasitic diseases, while its broader biological and clinical applications are still the subject of research.

Educational information: This article presents the results of published scientific studies and does not contain individual recommendations regarding treatment, dosage, or drug combinations.

 

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