Current Management of Cystic Echinococcosis; a survey of specialist practice.


Nabarro, LE; Amin, Z; Chiodini, PL; (2014) Current Management of Cystic Echinococcosis; a survey of specialist practice. Clinical infectious diseases. ISSN 1058-4838 DOI: https://doi.org/10.1093/cid/ciu931

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Abstract

Cystic echinococcosis (CE) is a significant public health problem worldwide. However, there remains a dearth of evidence guiding treatment in various stages of CE. The 2010 WHO Informal Working Group on Echinococcosis (WHO IWGE) guidance is thus based on expert consensus rather than good evidence base. This study aims to describe the way clinicians worldwide manage CE and to establish whether clinicians follow WHO IWGE guidance.  Using the online surveying tool SurveyMonkey(®), a questionnaire was produced detailing five clinical cases. Clinicians treating CE were identified and asked how to manage each case through tick box and short answer questions.  The results showed great variation in practice worldwide. There are practices in common use that are known to be ineffectual, including PAIR (puncture, aspiration, injection, re-aspiration) procedures on WHO type 2 cysts, or outdated, including interrupted, rather than continuous, courses of albendazole. A number of unsafe practices were identified such as using scolicidal agents in cysts communicating with the biliary tree and short course medical therapy for disseminated disease. Most clinicians do not follow the WHO IWGE guidance but the reasons for this are unclear.  Management of CE varies greatly worldwide. There are key areas of CE for which there is no evidence on which to base guidelines and randomised controlled trials are needed together with a well-designed international registry to collect data. Further work is required to establish why clinicians do not follow the IWGE guidance together with better dissemination of future guidance.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 25422388
Web of Science ID: 349766100009
URI: http://researchonline.lshtm.ac.uk/id/eprint/2030933

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