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Artemether and Praziquantel: Origin, Mode of Action, Impact, and Suggested Application for Effective Control of Human Schistosomiasis

1
Ingerod, SE-454 94 Brastad, Sweden
2
College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
3
Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
*
Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2018, 3(4), 125; https://doi.org/10.3390/tropicalmed3040125
Received: 19 November 2018 / Revised: 5 December 2018 / Accepted: 11 December 2018 / Published: 19 December 2018
(This article belongs to the Special Issue Prospects for Schistosomiasis Elimination)
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Abstract

The stumbling block for the continued, single-drug use of praziquantel (PZQ) against schistosomiasis is less justified by the risk of drug resistance than by the fact that this drug is inactive against juvenile parasites, which will mature and start egg production after chemotherapy. Artemisinin derivatives, currently used against malaria in the form of artemisinin-based combination therapy (ACT), provide an opportunity as these drugs are not only active against malaria plasmodia, but surprisingly also against juvenile schistosomes. An artemisinin/PZQ combination would be complementary, and potentially additive, as it would kill two schistosome life cycle stages and thus confer a transmission-blocking modality to current chemotherapy. We focus here on single versus combined regimens in endemic settings. Although the risk of artemisinin resistance, already emerging with respect to malaria therapy in Southeast Asia, prevents use in countries where ACT is needed for malaria care, an artemisinin-enforced praziquantel treatment (APT) should be acceptable in regions of North Africa (including Egypt), the Middle East, China, and Brazil that are not endemic for malaria. Thanks to recent progress with respect to high-resolution diagnostics, based on circulating schistosome antigens in humans and molecular approaches for snail surveys, it should be possible to keep areas scheduled for schistosomiasis elimination under surveillance, bringing rapid response to bear on problems arising. The next steps would be to investigate where and for how long APT should be applied to make a lasting impact. A large-scale field trial in an area with modest transmission should tell how apt this approach is. View Full-Text
Keywords: schistosomiasis; elimination; praziquantel; artemether; combination therapy schistosomiasis; elimination; praziquantel; artemether; combination therapy
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Bergquist, R.; Elmorshedy, H. Artemether and Praziquantel: Origin, Mode of Action, Impact, and Suggested Application for Effective Control of Human Schistosomiasis. Trop. Med. Infect. Dis. 2018, 3, 125.

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