Chronic Hepatointestinal Schistosomiasis (S. mansoni) — What to Do When Praziquantel Has Not Achieved Parasite Clearance
Clinical scenario
This protocol covers patients with chronic hepatointestinal schistosomiasis caused by Schistosoma mansoni — presenting with abdominal pain, chronic diarrhoea, rectal bleeding, and liver fibrosis, with eggs detectable in faeces — whose prior antiparasitic treatment did not achieve parasite clearance.
Prior treatment: failure criteria
The previous treatment was Praziquantel. Failure is defined as vital eggs still detectable in stool 3 months after treatment, or eosinophilia that has not resolved by 6 months after treatment. This protocol applies when those clearance targets were not met.
Next-line approach — partial overview
After Praziquantel failure, re-treatment or an alternative antiparasitic agent specific to S. mansoni infection is indicated. The complete selection criteria, agent choice, and treatment schedule are available in the full structured protocol.
References
- hepatointestinal S.: abdominal pain, chronic diarrhoea, rectal bleeding, liver fibrosis, ascites, portal hypertension, splenomegaly, variceal bleeding
- Egg detection in urine (S. h.) or faeces (other S. spp.)
- In the case of treatment failure re‑treat with Praziquantel
- (S. mansoni only: Oxamniquine 25 mg/kg p.o. TID on day 0 and on day 21‑30)
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