Biennial versus annual treatment for schistosomiasis and its impact on liver morbidity

Objective This study assessed the impact of annual versus biennial praziquantel treatment regimens on the prevalence, intensity of infection, and liver fibrosis dynamics of Asiatic schistosomiasis (caused by Schistosoma japonicum) among individuals residing in 18 endemic barangays in Northern Samar, Philippines. Methods Five hundred and sixty-five subjects who reported symptoms of gastrointestinal illness and/or were believed to have clinical morbidity based on physical examination were selected for cohort follow-up. Results The mean prevalence of schistosomiasis was 34% and the mean intensity of infection was 123.1 eggs per gram. Moderate to severe hepatic fibrosis (grade II/III) was demonstrated in approximately 25% of the study population. As expected, a greater reduction in both the prevalence and intensity of infection was documented with two treatment rounds versus one. Overall, hepatic fibrosis (grades I–III) regressed in only 24.3% of those who received a single treatment and in only 19.3% of those who received two doses. The prevalence of grade II–III fibrosis at baseline (25.2%) remained unchanged 2 years after treatment. Conclusions These findings suggest that in order to reverse moderate to severe liver fibrosis due to schistosomiasis and improve clinical outcomes, a higher clinical dosage of praziquantel (i.e., 60–80 mg/kg) may be required over an extended duration.