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Chemotherapy for AE involves albendazole (ABZ), which has shown insufficient efficacy. More effective chemotherapy for AE is needed. Previously, we have demonstrated that atovaquone (ATV), an antimalarial, inhibits mitochondrial complex III of\n                    <jats:italic>E<\/jats:italic>\n                    .\n                    <jats:italic>multilocularis<\/jats:italic>\n                    and restricts the development of larval cysts in\n                    <jats:italic>in vivo<\/jats:italic>\n                    experiments. Therefore, in this study, we evaluated the efficacy of ABZ and ATV combination therapy on\n                    <jats:italic>E<\/jats:italic>\n                    .\n                    <jats:italic>multilocularis<\/jats:italic>\n                    in culture and\n                    <jats:italic>in vivo<\/jats:italic>\n                    experiments. Protoscoleces were treated with 50 \u03bcM ABZ and\/or ATV in the medium; the duration of parasite elimination was determined under aerobic and anaerobic culture. In the\n                    <jats:italic>in vivo<\/jats:italic>\n                    experiment, the effects of ABZ and ATV combination treatment in BALB\/c mice infected orally with eggs from the feces of an adult-stage\n                    <jats:italic>E. multilocularis<\/jats:italic>\n                    -infected dog were compared with those of standard oral ABZ therapy. In the culture assay, the duration of elimination associated with ABZ and ATV combination treatment was shorter than that associated with ATV alone under aerobic conditions. Protoscolex viability progressively reduced owing to the combination treatment under anaerobic conditions; however, either drug used singly did not exhibit antiparasitic effects under hypoxia. Furthermore, compared with ABZ alone, the combination treatment significantly reduced the growth of the primary cyst in the liver of mice infected orally with parasite eggs (\n                    <jats:italic>P<\/jats:italic>\n                    = .011). ATV enhances the effect of ABZ in the treatment of AE in mice.\n                  <\/jats:p>","DOI":"10.1007\/s10096-021-04230-5","type":"journal-article","created":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T10:03:13Z","timestamp":1616752993000},"page":"1815-1820","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["In vivo efficacy of combination therapy with albendazole and atovaquone against primary hydatid cysts in mice"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6729-9789","authenticated-orcid":false,"given":"Shigehiro","family":"Enkai","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirokazu","family":"Kouguchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel Ken","family":"Inaoka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takao","family":"Irie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kinpei","family":"Yagi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiyoshi","family":"Kita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,3,26]]},"reference":[{"key":"4230_CR1","doi-asserted-by":"crossref","unstructured":"Wen H, Vuitton L, Tuxun T, Li J, Vuitton DA, Zhang W, McManus DP (2019) Echinococcosis: advances in the 21st century. 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In addition, the protocol for animal experiments was approved by the ethics committee of the Hokkaido Institute of Public Health (permit numbers: K25-2 and K29-4).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}