efficacy of azole derivatives, clotrimazole, itraconazole, and voriconazole on cystic echinococcosis protoscolices: a comparative study

Cystic echinococcosis (ce) presents significant public health challenges in various regions worldwide. the adverse effects and limited efficacy of current scolicidal agents, underscore the urgent need for novel therapeutics developments. this study aimed to evaluate the scolicidal effects of the azole compounds clotrimazole, itraconazole, and voriconazole on ce protoscolices. protoscolices were aseptically harvested from ovine hepatic hydatid cysts. after confirming high viability (over 90%) through eosin staining, the protoscolices were subjected to graded concentrations of clotrimazole, itraconazole, and voriconazole. a 20% saline solution served as the positive control, while a dmso solution (the drug solvent) used as the negative control. following a three-hour exposure period, eosin staining and microscopic examination were employed to determine the proportion of viable protoscolices. statistical analysis was conducted using spss software and anova tests. the results showed that the percentage of dead protoscolices in the presence of clotrimazole was significantly higher compared to the negative control and both itraconazole and voriconazole, although it was significantly lower than the positive control. the highest mortality rate in the clotrimazole group was observed at 1024 µg/ml, corresponding to an 89.9±63.69% mortality rate. the data also indicated a statistically significant correlation between increasing clotrimazole concentration and its mortality rate (p=0.011). these findings suggest that clotrimazole exhibits superior scolicidal activity against ce protoscolices compared to itraconazole and voriconazole, indicating its potential as an anti-parasitic medication, suitable for alternative or adjunctive treatment of this debilitating disease.