Observational study on effectiveness and safety of multiple regimens of Triclabendazole in Human Fascioliasis after failure to standard of care regimens.: Multiple regimens of Triclabendazole for Fasciola.

Abstract Introduction : Triclabendazole (TCBZ) is the recommended anthelmintic against Fasciola hepatica at a dose of 10mg/kg of body weight administered as a single or double dose. However, treatment failures of TCBZ to standard-of-care doses have been reported in humans. The aim of this study is to describe the effectiveness and tolerability of alternative TCBZ regimens in those patients who failed the standard of care regimen for fascioliasis in Peru. Methods : A retrospective study was conducted at a major referral center for fascioliasis in Peru between 2002 and 2018. The case search were only cases with chronic F. hepatica infection who failed the standard of care regimen for human fascioliasis with TCBZ at 10mg/kg orally as single dose with food. Results : A total of 27 cases (59% female; mean age 39.4 years-old; range 6-71) with chronic fascioliasis failed at least once to the current standard of care regimen of TCBZ. Out of 27, 21 failed to a second regimen of treatment. Multiple regimens of TCBZ were given to these patients until three consecutive stool examinations were negative for eggs of Fasciola. The overall cure rate was 74%. TCBZ was well tolerated with minimal side effects. Conclusions : We have found that patients labeled as “TCBZ resistance” may respond to multiple regimens of TCBZ with a cure rate of 74% according to the results of this study. The term “TCBZ resistance” should be re-evaluated using biomarkers.