Pharmacology and toxicology
Praziquantel is a highly effective broad-spectrum anthelmintic against many treinatodes and cestodes, but is also the first-line drug against schistosomiasis (bilharziosis). No teratogenicity has been reported in animal studies. A case report of a normal child, born after treatment of the mother from weeks 8 to 11, has been published (Paparone 1996). In a retrospective study, during treatment of their mothers for schistosomiasis 88 children were exposed to praziquantel (47 during the first trimester); no increase in adverse outcomes was reported (Adam 2004B). The same research team also followed and evaluated prospectively 25 pregnancy outcomes after exposure (6 during the first trimester) to praziquantel. Apart from one spontaneous abortion, no adverse outcomes were observed (Adam 2005). In another prospective study on anthelmintics, four pregnant women treated in the first trimester delivered four normal children (Reuvers-Lodewijks 1999). The health benefits, for both mother and unborn child, that are gained from the treatment for schistosomiasis arc viewed by many to outweigh by far the probably very small risk of adverse prcgnancy outcome (Olds 2003, Savioli 2003, WHO 2002).
Recommendation. Praziquantel is not recommended during pregnancy when other better-established anthelmintics are available. Treatment should be reserved for specific vital indications. Inadvertent use does not require termination of pregnancy or invasive diagnostic procedures. It is the firstline drug against bilharziosis.
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