Pharmacology and toxicology
Albendazole is a highly effective broad-spectrum anthelmintic, structurally related to mebendazole. It also kills the parasite through inhibition of the glucose uptake. It is the first-line drug for the treatment of alveolar forms of echinococcosis (Echinococcus multilocularis), and also for the advanced cystic forms (Echinococcus granulosus). During a mass drug administration for lymphatic filiriasis in Ghana, 50 women were inadvertently (because their pregnancy was not recognized) treated with ivermectin and albendazole; their pregnancy outcomes were compared with those of 293 women with a recognized pregnancy who were not treated. Of the 39 children who were exposed during the first trimester, 1 congenital malformation (a hearing impairment), versus 5 of the untreated group, was reported. The authors concluded that there was no evidence of increased risk after exposure to ivermectin and albendazole (Gyapong 2003). One Down syndrome was observed in a small prospective study of albendazole (n = 12) and ilubendazole (n = 11) (Choi 2005). No malformations were observed among 24 children born after first-trimester exposure to albendazole in a prospective study (Reuvers-Lodewijks 1999).
Thiabendazole is indicated for the treatment of strongyloidiasis, larva migrans cutanea, and trichinosis. There are no reports of thiabendazole use during human pregnancies.
Recommendation. When there is a vital indication for the treatment of echinococcosis, albendazole may be used during all stages of pregnancy. However, a small risk of birth defects cannot be excluded. For all other indications, more established anthelmintics should be used. When used during the first trimester, a detailed ultrasound diagnosis is recommended.
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