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Department of Medical Biology and Genetics Gaziantep University, School of Medicine Gaziantep, Turkey
ko
lu
Department of Medical Biology and Genetics Selcuk University, Meram School of Medicine Konya, Turkey
Department of Radiology Selcuk University, Meram School of Medicine Konya, Turkey
We very much appreciate Dr. Brunetti's comments on our article. Before the usage of antihelminthic drugs for animal trials, we undertook a comparative kinetic study to determine the time length (hr) of albendazole suspension toxicity on the viable protoscolices [1]. Albendazole suspension showed its toxicity 1 hr after its addition, and complete death of the protoscolices occurred at 48 hr (Table 1). Based on these findings, we carried out the animal study using either albendazole or mebendazole suspension treatment of cystic content. The results were encouraging regarding percutaneously treating the cystic lesion caused by Echinococcus granulosus.
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The oxidized form of albendazole (the sulfoxide) is generally considered to be the active metabolite responsible for the therapeutic activity [2]. We did not test sulfoxide but both in vitro viability tests [1] and percutaneous treatment of cystic content in animals [3] showed that the scolices are able to convert the albendazole to the oxidized form as pointed out in Dr. Brunetti's comments. The metabolism of albendazole in the intestinal wall and liver occur as both cytochrome P450 oxidases (albendazole [–] form) and other flavin oxidases (albendazole [+] form) [2]. Apparently, albendazole in the solution is metabolized by the scolices, and one of the enantiomers produced is effective in the therapeutic activity as obtained in our studies [1, 3].
Although we have not studied the pharmacokinetics of the drug, the percutaneous treatment has been chosen to circumvent malabsorption of albendazole by the laminated cysts. Our results and the results reported elsewhere [4–6] indicate that albendazole is as equally effective as its derivative.
Erzurumlu et al. [7] have reported that albendazole solution also was shown to be safe and reliable in the percutaneous treatment of hydatidosis.
Results of the study reported by Yetim et al. [4] have shown that both alcohol and albendazole are effective in rabbits as scolecocidal agents in percutaneous treatment of experimental hydatid liver disease. Albendazole solution was found to be more effective compared to alcohol [4].
When albendazole is administered orally it is converted to albendazole sulfoxide and this form reaches the cyst's fluid. A search of PubMed does not show any research indicating a lack of scolecocidal effect on the part of albendazole. Moreover, the clinical antihelminthic efficacy and in vitro scolicidal effect of albendazole were reported earlier [1, 6, 8, 9]. Urrea-Paris et al. [9] showed that albendazole has scolecocidal effect under in vitro conditions.
 Top References |
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lu H. Hydatid kistle infekte organlarda
skolosidal maddelerin canli skolekslere etkisinin histolojik incelenmesi [in
Turkish]. [Histological examination of efficacy of scolicidal agents on the
viable scolices of various organ involvement with hydatidosis.]
(thesis) Konya, Turkey: Selçuk University, Institute of Health
Sciences; 1996
M,
Çevikba
U. The effect of intra-operative
mebendazole-albendazole application on the hepatobiliary system.
Eur Surg Res 1995;27
: 340-345[Medline]
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