Abstract
Purpose Echinococcosis remains a major neglected zoonosis with limited therapeutic options. Thymol and carvacrol have emerged as experimental anti-echinococcal candidates, yet their mechanistic basis, translational relevance, and major limitations including the absence of clinical evidence remain incompletely defined. This review critically evaluates available evidence on their anti-echinococcal activity, examines proposed mechanisms of action, and identifies key barriers that must be addressed for therapeutic development. Methods A substantial body of experimental research has been conducted to evaluate their efficacy, and this narrative review synthesizes and critically examines available evidence regarding their anti-echinococcal activity and proposed mechanisms of action. Results Available experimental evidence indicates that both isomers exhibit anti-echinococcal activity in in vitro and in vivo models involving Echinococcus granulosus sensu lato and Echinococcus multilocularis . Their effects are mainly associated with tegumental membrane disruption, accompanied by ultrastructural alterations, while evidence supporting apoptosis-like pathways remains preliminary and incompletely validated. Experimental studies indicate synergistic or additive interactions with albendazole, suggesting possible mechanistic complementarity, although the basis of these interactions remains incompletely defined. Conclusion Although experimental evidence supports membrane-disruptive and anti-echinococcal activity of thymol and carvacrol, current evidence remains largely preclinical and insufficient for therapeutic translation, particularly in the absence of clinical research data. Major uncertainties including poor aqueous solubility, limited bioavailability, lack of intracystic pharmacokinetic data, methodological heterogeneity, and incompletely validated mechanistic pathways remain unresolved. These monoterpenoid phenols should therefore be regarded as promising experimental candidates rather than clinically translatable agents, pending rigorous preclinical validation.