Costs and Prescribing Patterns of Anthelmintics in the United States Military: A Retrospective Analysis

Anthelmintics in the environment: Their occurrence, fate, and toxicity to non-target organisms

Anthelmintics are drugs used for the treatment and prevention of diseases caused by parasitic worms (helminths). While the importance of anthelmintics in human as well as in veterinary medicine is evident, they represent emerging contaminants of the environment. Human anthelmintics are mainly used in tropical and sub-tropical regions, while veterinary anthelmintics have become frequently-occurring environmental pollutants worldwide due to intensive agri- and aquaculture production. In the environment, anthelmintics are distributed in water and soil in relation to their structure and physicochemical properties. Consequently, they enter various organisms directly (e.g. plants, soil invertebrates, water animals) or indirectly through food-chain. Several anthelmintics elicit toxic effects in non-target species. Although new information has been made available, anthelmintics in ecosystems should be more thoroughly investigated to obtain complex knowledge on their impact in various environments. This review summarizes available information about the occurrence, behavior, and toxic effect of anthelmintics in environment. Several reasons why anthelmintics are dangerous contaminants are highlighted along with options to reduce contamination. Negative effects are also outlined.

Medical management of cystic echinococcosis

PURPOSE OF REVIEW

Cystic echinococcosis is a neglected zoonosis for which humans are dead end hosts. It is not only widely distributed in sheep rearing areas of low-income and middle-income countries but also has a significant presence in wealthy countries, for example, in Europe. It results in considerable morbidity, and its current management is far from optimal. Medical management is with a benzimidazole, with the addition of praziquantel under some circumstances.

RECENT FINDINGS

Interest in mebendazole as an anticancer drug has stimulated research into new drug formulations to improve bioavailability and possibly reduce inter-individual variability in in-vivo drug levels, which may help its activity against cystic echinococcosis. Further evidence to support administration of albendazole with a fatty meal has been provided. GlaxoSmithKilne (GSK) has agreed to extend its albendazole donation programme to include echinococcosis. The search for new drugs has focussed on natural products, such as essential oils and on repurposing of existing drugs licensed for human use against other conditions.

SUMMARY

The medical treatment of cystic echinococcosis remains sorely neglected, with no new drugs for almost 40 years. We need a better understanding of how to use the drugs we do have, whilst seeking new ones. Drug repurposing may be the best pathway.