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A female adult suffering from fish tape-worm infection was successfully treated with a single oral administration of 4,000 mg aminosidine, a paromomycin. The drug concentration in the segments of the worm removed were as high as 600 mg/ml or more, meanwhile, serum level and urinary recovery in the patient were very low. Consequently, it was presumed that some acute effect, such as neuro-muscular toxicity, of the drug, which was well absorbed into parasite, but ill-absorbed from the gastrointestinal tract of human, is one of the mode of antihelminthic activity, in this case.

Recently, it has been known that the treatment with paromomycin sulfate is effective against many kinds of tapeworm. Paromomycin sulfate was used for treating 56 patients with Diphyllobothrium latum aged 2 approximately 65 years old. Paromomycin was administered orally in the dose of 25 approximately 50 mg/kg. All cases with Diphyllobothriasis latum were successfully treated with paromomycin. The drug was well tolerated and no side effects were observed in any patients.

The absorption, excretion and influence on bowel flora of oral paromomycin sulfate (aminosidine, PRM) were studied in ten normal volunteers taking a normal diet, and the following results were obtained. 1. Serum levels of PRM were observed 0.46 micrograms/ml at a half hour, 1.14 micrograms/ml at 1 hour, 1.48 micrograms/ml at 2 hours, 0.70 micrograms/ml at 4 hours, 0.29 micrograms at 6 hours and were almost faded out at 12 hours after 4 grams of oral administration. 2. During 0 approximately 2 hours, 2 approximately 4 hours, 4 approximately 6 hours and 6 approximately 12 hours, the mean urine concentration of PRM were observed 56.4 micrograms/ml, 56.2 micrograms/ml, 37.1 micrograms/ml and 13.8 micrograms/ml, respectively, and the total excretion in the urine by 12 hours were observed 21.14 mg (0.53%). 3. Oral administration of PRM caused fall in Lactobacillus, non spore-forming anaerobic Gram positive bacilli (BEP group) and Peptostreptococcus (P less than 0.001), Bacteroides (P less than 0.01). However, after administration was discontinued, reduced bowel flora was returned to the normal range within a few days. No overgrowth of bowel flora by coliform, Clostridium or yeast was observed. Klebsiella oxytoca and toxigenic Clostridium difficile were not observed overgrowth. 4. No side effect was observed clinically over 2 months.

About 50 mg/kg of paromomycin sulfate was administered orally in a single or 2 divided doses to patients with Diphyllobothrium latum infections. The following results were obtained. After the treatment with paromomycin sulfate mature strobilae were expelled in all of 7 patients with Diphyllobothrium latum infections. We couldn't find scolices in all cases. Although these stools were examined for 2 months after the treatment, the eggs of Diphyllobothrium latum were not identified. No side effects were observed in all cases. It was concluded that paromomycin sulfate was effective on the treatment of Diphyllobothrium latum infections.

Forty-one patients, aged 2 to 68 years old, infected with Diphyllobothrium latum in Akita prefecture were treated using paromomycin sulfate from 1974 to 1981. Paromomycin sulfate was administered orally in a single dose of 20, 30 mg/kg or 50 mg/kg. Twenty-three cases expelled tapeworms. However, only 9 (28.1%) out of 32 tapeworms expelled had their scolex. It can be said that all cases were successfully treated with paromomycin sulfate, since they showed the egg-negative on 3 weeks or 1 month after the treatment. The drug was well tolerated and no side effects were encountered in any patients. It was suggested that paromomycin sulfate was effective and also safe therapeutic agent for the treatment of D. latum infection.

Mesocestoides tapeworm is a common cestode in carnivorous mammals, but human infection with the tapeworm of this genus have been infrequent. We have recently observed the 13th case of human infection with Mesocestoides lineatus in Japan. A 35-year-old man living in Gifu prefecture was admitted to our University Hospital with chief complaints of general fatigue and discharge of cestode segments in his stool. The patient gave a history of drinking blood and eating the raw liver of a snake Agkistrodon halys for medicinal purposes as same as the previous cases of all reported in Japan. The segments were identified as those of M. lineatus. He was treated orally 3 g of paromomycin sulfate. Stool examination after treatment with paromomycin sulfate revealed no evidence of parasitism. The present case may be the 2nd to have been successfully treated with paramomycin sulfate and the 21st case of Mesocestoides tapeworm infection in man described in the literature.

Plerocercoids of D. ditremum were obtained from the Japanese surfsmelt (Hypomesus pretiosus) and administered to Golden hamsters. The animals were treated with paromomycin sulfate on the 16th day of infection. Anthelmintic effect was imperfection after administration of 530 mg/kg in 4 divided doses. Kamala and bithionol, however, successfully expelled the worm at the doses of 80 and 160 mg/kg and 12.5--70 mg/kg, respectively. The balloon-like structures and the other morphological changes of the tegument such as exfoliation of microtriches were remarkably observed on the worms immersed in 2% solution of paromomycin sulfate. Four human cases of diphyllobothriasis were treated with paromomycin sulfate at the doses of 46--56 mg/kg. No side effects were observed. Stool examination made 1 month after treatment were negative to the eggs. From these results, an anthelmintic effect of paromomycin sulfate was shown in the concentration of 2% on D. ditremum in vitro and in the dosage of 46--56 mg/kg in diphyllobothriasis lata patients.