The data are inadequate to assess safety and efficacy of mass chemotherapy for Taenia solium taeniasis

As members of the Pan American Health Organization (PAHO) and World Health Organization (WHO) guidelines development group on chemotherapy strategies for the control of Taenia solium taeniasis, we are very disappointed at the systematic review by Haby and colleagues. With respect to the analysis of efficacy, the authors did not account for differences in the methods used to ascertain the outcome in the studies analyzed. There are also major concerns regarding the safety analyses. Few of the included studies used carefully designed active surveillance protocols to detect epileptic seizures and/or chronic progressive headaches. These neurologic side effects, due the inadvertent killing of viable brain cysts, have been noted after mass therapy with praziquantel and albendazole. We wholeheartedly agree with the authors' statement in their discussion that control programs applying chemotherapy using mass drug administration "need to be informed by evidence of the best drug and dose in terms of efficacy and side-effects." Unfortunately, the flawed analysis that was published is contrary to that goal.