Applied Bacteriology , parasitology & pharmacology

PREPARED BY Dr. Mohammed Ibraheem (- Qena - Qus hospital )

((Bacteria ))
Staphylococci : G +ve Cocci ‫ا
رات ا
د‬
*Staph .aureus ‫ا
دت ا
ه‬
Pyogenic infection (1st generation cephalosporins , cloxacillin)
Osteomylitis ( 1st generation cephalosporins , vancomycin)
Wound infection (1st generation cephalosporins , cloxacillin)
Bronchopneumonia ( 1st generation cephalosporins , vancomycin)
Hospital acquired infection
Food poisoning
Toxic shock syndrome
Scaled skin syndrome (totacef100mg/kg/day followed by keflex x7days)
*Staph . epidermidis (commensal ) 
‫ا
دت ا‬
Normal flora of skin
Infection of prosthetic devices ( vancomycin )
*Staph . saprophyticus (commensal ) ‫ا
دت ا
ﻡ‬
UTI ( in sexually active girls)
----------------------------------------------------------------------------------------------------------------
Streptococci : G +ve Cocci 
‫ا
رات ا‬
*Group B strepetoccoi (GBS)
Neonatal sepsis & meningitis ( penicillin G, ampicillin )
* Group A streptococci (GAS)
Acute tonsillitis,Scarlet fever ( penicillin V, benzathine penicillin )
Impetigo,Erysipelas ( penicillin –ampicillin – amoxicillin x 10 days)
Acute bacterial endocarditis
Acute glomerulonephritis
Acute rheumatic fever
* Streptococcal viridans (oral flora) ‫ا
ت ا
ة‬
Subacute bacterial endocarditis (penicillin G+ gentamycin) or (vancomycin)
* Streptococcal faecalis ( enterococci )( GIT flora ) ‫ا
از‬
UTI, Subacute bacterial endocarditis ( ampicillin + amikacin )/vancomycin
---------------------------------------------------------------------------------------------------------

* Streptococci pneumoniae : G+ve capsulated diplococci  

‫ا
ت ا‬
Lobar, bronchopneumonia ,Sinusitis , Otitis media (penicillin, amoxicillin ,macrolide )

Bacteremia ,meningitis,arthritis (penicillin G, cefotaxime/ceftriaxone for relatively resistant ,

vancomycin for resistant strains )

Neisseria G-ve Diplococci ‫ا

ت‬
*Neisseria Gonorrhoeae 
‫ا
ت ا‬
1
 Sexually transmitted disease
Gonorrhea ,Ophthalmic neonatorum ,Vulvo vaginitis (ceftriaxone,cefixime )
*Neisseria Meningitidis  
‫ا‬
Epidemic cerebrospinal meningitis
Meningococcal septicemia ( penicillin- ampicillin)
-------------------------------------------------------
Moraxella :G-ve diplobacilli (flora of oropharynx )
*M . cataralis
sinusitis ,otitis media ,bronchitis ( augmentin )
pneumonia (in immunocompromized)
*M.lacunata
angular conjunctivitis , blepharitis
---------------------------------------------------------
Diphteria : G+ve bacilli
Diphteria
-------------------------------------------------------
listeria monocytogenes :G+ve bacilli ‫
" ا
"ﺡة‬
zonootic
Neonatal meningitis ( ampicillin )
----------------------------------------------------------------------------------------------------------------
clostridium G+ve anaerobic bacilli ( flora of GIT of man& animal)
*C.tetani ‫از‬#
‫ت ا‬$%
‫ا‬
Produce tetanus ( metronidazol / penicillin + antitoxins )
*C. perfringens &
‫ا‬
Produce gas gangrene ( metronidazol / penicillin + antitoxins)
*C difficle  '
‫ا‬
Pseudomembraneus colitis ( metroniazol )
*C botulinum : (
‫ا‬
flora of GIT of domestic animals , saprophyte of soil
Produce botulism
Bacillus anthracis : G+ve bacilli
Anthrax ( penicillin )
Bacillus cereus
Food poisoning
-----------------------------------------------------------
Enterobacteriaceae G-ve bacilli
Ecoli,citrobacter,klebsiella,enterobacter,salmonella,shigella,proteus
Normal flora of GIT of man except shegilla & salmonella are pathogenic

2
Ecoli
UTI, Diarrhea ,neonatal meningitis
Bacteremia , septic shock
Hospital acquired infection
Citrobacter
Similar to E coli
UTI
Klebsiella
K pneumonia,UTI
Enterobacter
UTI
Salmonella
Enteric fever
Food poisoning
Bacteremia é focal lesions osteomylitis,pneumonia, meningitis
Shigella
Bacillary dysenrery
Proteus (vulgaris, mirabilis,morgani,providencia) "
‫ا‬
Wound infection,otitis media
Pneumonia , bacteremia, UTI
Pseudomonas : G-ve bacilli ) ‫ا‬#
‫ا‬
UTI,wound infection,burn,otitis media
Nosocomial infection
Highly reistant to antibiotics
--------------------------------------------------------
vibro cholera : G-ve comma shaped bacilli
cholera
campylobacter :G-ve s shaped bacilli
C jejuni, C.Coli
zoonotic
diarrhea
Helicobacter pylori G-ve s shaped bacilli with flagella
Gastritis , peptic ulcer
Brucella : G-ve Coccobacilli
Zoonotic
Brucellosis
--------------------------------------------------------
Yersinea : G-ve Coccobacilli
Zoonotic
Y pestis ------------


plaque

3
Y enterolytica ------


AGE

----------------------------------
Hemophilus G-ve coccobacilli ‫ا
"ﻡ‬
H influ
Throat flora
Pneumonia , AOM, Sinusitis , meningitis , bacteremia
H aeyptius
Acute purulent conjunctivitis
H bucreyl
Chancroid (soft sore ) sexually transmitted
--------------------------------------------------------------------------------------------------
Bordettella pertusus G-ve coccobacilli *‫ه‬+
‫ا‬
Whooping cough
--------------------------------------------------------------
Mycobacterium tuberculosis : acid fast bacilli 
‫ة ا‬%)"
‫ا‬
TB

Mycobacterium lepra : acid fast bacilli ‫ام‬#

‫ة ا‬%)"‫ﻡ‬
Leprosy

Mycoplasma ‫رات‬%)
‫ا‬
M pneumoniae -------


atypical pneumonia
Ureaplasma ---------


urethritis
M hominis --------


purpural sepsis
------------------------------------------------------
Legionella ‫ا
)ت‬
L pneumonia , Pontiac fever
--------------------------------------------------------------------------------------------------------------
Spirochaetes : spiral motile organism ‫ا
"ت‬
Treponema ------------

syphilis
Borrelia -------------

relapsing fever, lyme disease, vincent angina
Leptospira ---------

leptospirosis
----------------------------------------------------------------------------------------------------------------
Chlamydia : obligate intracellular organism related to G-ve bacteria ‫ا
"ﺙات‬
C . trachomatis : Trachoma, urethritis,l ymphogranuloma venerium
C.psittaci ------

psittacosis (bird)
C.pneumoniae ---

atypical pneumonia
----------------------------------------------------------------------------------------------------------------
Rickettsia : obligate intracellular coccobacilli transmitted by arthropods
Typhus (epidemic,endemic ,scrub )
Rocky mountain spotted fever

4
Trench fever
Q fever
Anaerobic infections :
G-ve bacilli --


propionibacterium(skin flora ) ,lactobacilli (vaginal flora)
G+ve cocci --

peptosteptococcus ( skin& mm flora)
G-ve bacilli --


bacteriods,,fusobacterium (, URT, GIT,Genital tract flora )
G-ve cocci --

veillonella ( flora of mouth& URT )
Brain abscess,lung abscess,aspiration pneumonia
Chronic sinusitis,otitis media,peritonitis, periodontitis
-----------------------------------------------------------
Normal flora :
Skin : staph epidermidis & others
Nose : staph areurs
Mouth : sterpt viridans & anerobes
Colon : E coli,sterp fecalis,enterobacter,cl perfringens,klebseilla, citrobacter, anerobes
Vagina:lactobacillus,GBS,candida albicans,anerobes
Penis : staph epidermidis
Nosocomial infection ( hospital acquired infections)
Staph aeureus , E coli , pseudomonas.
*********************************************************************
(( ‫ت‬%)
‫ ا‬Fungi))
Superfacial mycosis --


tinea verscolour
Cutaneus mycosis ---

dermatophytes (ring worm, tinea )
---


cutaneus candidiasis ( candida albicans )
SC mycosis ------

mycetoma
Systemic mycosis ----

coccidiomycosis , histoplasmosis
Opportunistic ---


candidiasis , cryptococosis , asperillosis
-----------------------------------------

Coccidiomycosis : .‫ ا
واﻥ‬%)
‫داء ا‬
Coccidiodes immitis is asoil fungus endemic in America
Mode of infection : inhalation of spores containing dust in desert
Clinical features : fever , malaise ,cough, aches
Disseminated infection to bone & CNS ( after 1yr )
Investigation : microscopic ex ( sputum,spinal fluid, biopsy )
: detection of specific antibodies
TT : Amphotrecin B
------------------------------------------

5
Histoplasmosis : ‫داء ا
ﺱت‬
Histoplasma capsulatum is asoil fungus endemic in America
Mode: inhalation of spores contaminating with soil from excreta of birds &bats
Acute pneumonia or chronic cavitary lesions
Lymphadenopathy & splenomegaly
TT : THE SAME
--------------------------------------------

Candidiasis : ‫داء ا
ت‬
Normal flora of GIT, Respiratory tract , female genital tract
Old age , diabtes ,steroids, antibiotics , Immunocompromized patients

Superfacial infctions : oral thrush , vulvovaginitis , napkin dermatitis, paonychia

Systemic infections :
Pulmonary , kidney ,other organs
Disseminated candidiasis
Chronic mucocutaneous candidiasis syndrome with T CELL dysfunction
TT : nystatin , ketoconazol,amphotericin B
--------------------------------------------
Cryptococcosis : ‫داء ا
")ت‬
Cryptococcus neoformans is asoil fungus found in pigeon excreta
Inhalation of fungal spores
Pneumonia in pigeon breeder
Chronic meningitis with remission and exacerbation
--------------------------------------------

Aspergillosis ; ‫ا
((ت‬
Aspergillus fumigatus is the commenest
Inhalation of air born spores at construction sites near hospitals
Hypersensitivity syndromes ;
Asthma ; acute onset of af wheezing without pulmonary infiltrate
Extrinsic alveolar alveolitis : fever ,cough, dyspnea , ronchi witout wheezes
Allergic bronchopulmonary aspergillosis :
Preexisting asthma,or cystic fibrosis
Recurrent asthma
Expectoration of mucus spirals containing mycelia
Proximal bronchiactasis
Skin test ( RAST ), increased total IGE , esinophilia , detection of antibodies
Cortisone , bronchodilators, itraconazol
Non invasive syndromes :
Otomycosis : chronic , unilateral , associated with staph & pseudomonas
Sinusitis : chronic not responding to antibiotic therapy
Aspergilloma : complicate pul TB , sarcoidosis ,
Fungal ball in TB cavity
6
Invasive syndromes :
Otitis externa : spreed to petrous bone & pinna
Pneumonia & disseminated infections :
Fever ,cough , dyspnea , abnormal chest finding , coexisting sinusitis
Nodular infiltrate , cavitary shadow
Skin : necrotic eschars , echthyma gangrenosum
Eye : focal retinitis , retinal hge
CNS : single , multiple focal lesions
Hemiparesis , cranial nerve palsy , seizures
Progression of herniation is rapid
CT brain , CSF , brain biopsy
BONE : chronic granulomatous disease , affect vertebrae
Heart : endocarditis
**********************************************************************

((‫ا
)وﺱت‬viruses))
enterovirus  
‫ا
)وﺱت ا‬
poliovirus --


poliomyelitis
coxachievirus


herpangina,pleurodynia,myocarditis,aseptic meningitis
hepatitis A ---


Hepatitis
-----------------------------------------------------------
Rhinovirus ----


Common cold
------------------------------------------------------
influenza virus ------


influenza
-------------------------------------
parainfluenza virus -


common cold, ALTB(CROUP)
------------------------------------
Arbovirus
Viruses transmitted by arthrpodes ( mosquito )
Encephalitis , yellow fever,dengue , sandfly fever, riftvally fever
--------------------------------------------------------
Mumps virus -


mumps
------------------------------------------------------
measles virus --


measles
----------------------------------------------------------

7
Rubella virus ---- rubella, congenital rubella syndrome
Ruta virus ---


infantile AGE
Rabirs virus ----------

rabies
HIV virus -----


HIV
CMV ( 6
7
‫ ا
)وس ا‬-‫وس ا
م‬4 )
Congenital infection(TORCH) , Pneumonia(immunocompromized),IMN like syndrome
Herpes virus
Herpes simplex
gingivostomatitis, keratoconjunctivitis,encephalitis,genital herpes,neonatal hrpes
Varicella zoster virus
Chicken pox , zoster
---------------------------------------------------------------------
EBV ------


IMN ( infectious mononucleosis )

Hepatitis virus --

Hepatitis A,B,C,D,E,G

Adenovirus 8
‫ا
)وﺱت ا‬
Acute phayngitis,pharyngoconjunctivitis ,keratoconjunctivitis,
AGE, Pneumonia , acute hemorrhagic cystitis
************************************************************************************

(( Protozoa .
‫وا‬9‫))ا‬
Amebiasis : ‫ﻡت‬:‫ت –داء ا‬:"
‫ا‬
Aetiology : E histolytica
Mode of infection : ingesion of cyst containing food & drink
Intestinal amebiasis :
common in children 1-5yrs
Acute (amebic dysentery ): frequent motion with blood& mucus
Chronic:episodes of diarrhea& constipation & vague abdominal pain
A symptomatic : cyst passer
Extra intestinal : liver , lung , brain, skin
Investigation : stool ex. Trophozoites (loose ) cyst ( formed )
TT : acute : metronidazol , secnidazol
Chronic : furamide , secnidazol (NB: furamide , furazol > 2yrs )
Amebic hepatitis :
Fever ,rigors, sweating
Earthy look
Dull aching pain at Rt. Hypochondrium
Tender hepatomegaly
Rt basal sign ( effusion , consolidation )
Abd . ultrasonic, PNLS , increased ALP
Metronidazol x 10 days
Antibiotics for secondary bacterial infection
Closed needle aspiration 9 intercostals space

8
Open drainage : left lobe abscess, huge multiple abscess, very thick pus, failed aspiration
Amebic menngoencephalitis :
Organism : neglaria , acanthameba
Mode : through swimming pools
C/P : frontal headache , vomiting, neck rigidity , confusion & coma
Investigations : purulent CSF without bacteria
Wet drop preparation show motile trophozoites
ELISA, FAT, CIE
TT : IV/Intrathecal amphotercin B + Micronazol + PO Rifampicin
NB ; Amebic meningitis is seldom diagnosed before an individual's death ,
Suspect : history of water exposure, purulent CSF without bacteria , unresponsive to routine
antibacterial
Giardiasis : ‫ا
رد‬
Etiology : G . lambilia
Mode : ingestion of cyst contaminating food& drink &auto infection
C/p ; Chronic diarrhea with features of malabsorption
Investigations : stool analysis ( trophozoites in loose stools ) ( cyst in formed stools )
TTT : metronidazol x 7 days
------------------------------------------------------------------------------------------------------
Trichomonas : ‫ ة‬+
‫ا‬
Etiology : trichomonas vaginalis ( trophozoites only )
Mode : sexual intercourse , indirect contact
C/P : vaginal & urethral discharge

trophozoites
Investigations : discharge for microscopical ex.

TTT: metronidazol for both partners
Blantidiaisis : - ‫*ت ا

ﻥ داء ا
ت‬#
‫داء ا‬
Etiology : B Coli ( parasites of pigs& monkeys )
Mode : ingesion of cyst contaminating food & drinks
C/P : B dysentery ( frequent motions with blood & diarrhea )
TTT: Tetracycline
Leishmaniaiasis : ‫ﻥ‬+
‫داء ا‬
Visceral L , Cutaneous L , mucocutaneous L .
Distrebution : Africa, south America, India
*Visceral leishmania : ( kalazar )
Etiology : leishmania donovani
Mode : sand fly bite, blood transfusions, transplacental
C/P : irregular fever , anemia, cachexia , huge splenomegaly , hepatomegaly ,lymphadenopathy
Investigations : direct smear from aspirate , IFA,ELISA, L . skin test
TTT: pentosan , pentamidine , supportive TT
Cutaneuos leishmania : ( Oriental sore )
Etiology : leishmania tropica
Mode : same
C/P : Chronic ulcer on exposed parts with sharp edge &indurated margins
Investigations : the same
TTT: the same , thermo therapy , radiotherapy
Mucocutaneous leishmaia :
Etiology : leishmania brazillenisis
Mode : same
C/P : ulcer at nasolibial regions
Investigations : the same

9
TTT: the same , thermo therapy , radiotherapy
--------------------------------------------------------------------------------------------------------------
African Trypanosomiasis : ;49‫ت ا‬$
‫( ا‬sleeping sickness ) ;49‫داء ا
م ا‬
Etiology : T . bruci
Mode : tse tse fly bite (glossina )
Distribution : equatorial Africa
C/P : chanchre : firm,tender,painful nodules
Parasitic toxemia ( fever headache ,myalgia )
Lymphadenopathy , hepatosplenomegaly
Meningoencephalitis , headache , drowsness& coma
Investigations : direct smear, ELISA, IFA
TTT:Suramine , pentamidine, MEL B , MEL. W
American Tryponosomiasis ( chagas disease )
Etiology : trypanosoa cruzi
Mode :bite of kissing bugs
Distribution : south America
C/P :
Acute : chagoma (skin furancle ) unilateral conjunctivitis , splenomegaly , LN ++ , fever
Chronic : cardiomyopathy, megaesophagus , megacolon , endocrinal dysfunctions
Investigations : direct smear, ELISA, IFA
TTT Nifurtimox (Lampit) -- Used to treat acute and congenital Chagas disease. It decreases the
period of acute disease and decreases the mortality rate from myocarditis and
meningoencephalitis. – also Benznidazole (Rochagan)
Malaria : ‫ر‬6
‫ا
داء –داء ا‬
Etiology : plasmodium oval , vivax, malariae, falciparum
Mode : anopheles bite
C/P : prodrome of malaise,nausea, vomiting , headache
Paroxysmal : cold , hot, sweating stage
Tender splenomegaly , anemia
Investigations : blood film (thick ,thin )
TTT: chloroquine, fansidar , mefloquine
Chemoprophylaxis : chloroquine, fansidar
Malignant malaria :
Etiology : P falciparum
Mode : same
C/P : uncomplicated : as above
Complicated : cerebral malaria, black water fever, algid malaria
Investigations : the same
TTT: the same
Toxoplasma : ‫ا
ﺱت‬
Etiology : toxoplasma gondii ‫ﻥ‬8
‫ا
ﺱت ا‬
Mode : eating undercooked infected meat,
Ingestion of contaminated food with cat feces ,
Tran placental
C/P : Mononucleosis like syndrome
Prolonged low grade fever
Malaise & weakness
Generalized lymphadenopathy
Transient splenomegaly
Atypical lymphocytosis
**Congenital toxoplasmosis :

10
Hydrocephalous ,chorioretenitis, IC calcifications
Convulsions, jaundice, purpura , hepatosplenomegaly
Abortion , stillbirth
Asymptomatic 90%
Investigations :detection of Ig M ( Dye test , IFA, CFT )
TTT: Pyrimethamine + sulphadiazine x 1mo.
Folic acid
Steroids in chorioretenitis
Fansidar
Spiramycin ( in pregnant)
Isosporiasis : ‫ﻡ"ﺙ ا
ات‬
Etiology : isspora belli ( intestinal protozoa, dog parasite ) opportunistic organism
Mode :ingesion of oocyst contaminating food & drink
C/P : chronic diarrhea with features of malabsorption syndrome
Investigations : stool analysis ( oocyst )
TTT: septrin
Cryptosporidium : )
‫ت ا‬8
‫ا‬
Etiology : cryptosporidium ( intestinal protozoa ) opportunistic organism
Mode :ingesion of oocyst contaminating water
Close association with infected cow
C/P :profuse watery diarrhea (10l/day ) , malabsorption & lactose intolerance
Chronic diarrhea in immunocompromized Pt.
Investigations : stool analysis ( oocyst )
TTT: paromycin , azithromycin , Bismuth subsalicylate , supportive TT
Pneumocysts carnii : ‫ا
"= ا
 ى‬
Etiology : pneumocysts carnii ( opportunistic organism )
Mode : droplet infections
C/P : interstitial pneumonia , severe respiratory distress , immunocompromized pt.
Investigations : CXR diffuse interstitial infiltrate ,
Isolation of organism by broncheoalveolar lavage
TTT: Gamma globulin , cotrimoxazol , pentamidine

((Helminthes ‫)) ا
ان‬
Ascaris lumbricoides ?%
‫ ﺙ ن ا‬-.&‫ا@ﺱرس –ا
') ا
ا‬
Etiology : ascaris lumbricoides
Mode :ingestion of contaminated vegetables
C/P : vague abd. Pain, polyphagia , nervous manifestation, intestinal obstruction
Investigations : stool analysis
TTT: mebendazol , albendazol
Visceral larva migrains : toxocariasis ‫ت‬A
‫ا‬
Etiology :toxocara canis & cati ( Larva of non human ascaris – ascaris of dog & cat )
Mode :ingestion of eggs with handling cats& dogs
C/P : fever , , tender hepatomegaly, pneumonitis , urticaria , periorbital edema
Investigations : esinophilia , liver biopsy , FAT, ELISA
TTT: Hetrazan, thiabendazol, mebendazol , cortisone
---------------------------------
Enterobius vermicularis ( oxyuris ) ‫ا
ان ا
ﺏﺱ‬
Etiology : enterobius vermicularis
Mode :ingestion of contaminated food& drink – autoinfection
C/P : pruritic ani , insomnia& irritability, vulvoaginitis, appendicitis

11

eggs
Investigations :perianal swab -

TTT: mebendazol ( repeat ) - white PPT
--------------------------------------------------------
Trichuris trichura ( D
‫ (  ا‬-‫(  ا
أس‬whipworm &
‫) ا
ان ا‬
Etiology : Trichuris trichura ( human are the only host )
Mode : ingestion of mature eggs with infected food & vegetables
C/P : vague abd. Pain, bloody diarrhea, rectal prolapse, anemia
Investigations :stool analysis
eggs
TTT: mebendazol - albendazol
--------------------------------------------------------------------------------------------------------------
Ancylostoma 4%
‫ﻥﺱ"ﻡ –ا
ان ا‬9‫ا‬
Etiology : ankylostoma duodenal , necator Americana
Mode : contact barefoot with infected soil
C/P : anemia , anorexia , pica
Investigations :stool analysis
TTT: albendazol , mebendazol
Cutaneous larva migrans E‫اﺡ‬#
‫ ا‬F)%
‫داء ا‬
Etiology : larva of ankylostoma brazilianse& caninum (larva of non human hookworm )
Mode :contact with contaminated feces of dogs & cats
C/P : creeping eruption , allergic reaction
Investigations :clinically- esinophilia
TTT: thermotherapy & Ivermectin , Albendazole, thiabendazol

--------------------------------------------------------------------------------------------------
Strongyloidiasis ‫اﻥت‬%‫ﺱ‬9‫ا‬
Etiology : Strongyloides stercoralis ‫اﻥ ا
از‬%‫ﺱ‬9‫ا‬
Mode : contact barefoot with contaminated soil
Distribution : tropical & subtropical
C/P : duodenitis , malabsorption ,hypoprotenemia ,peripheral edema pneumonitis
Investigations :stool analysis -

larva , duodenal aspirate , CFT
TTT:albendazol , thiabendazol x one weak
-------------------------------------------------------------------------------------------------
Trichenosis
Etiology : Trichinella spiralis ‫وﻥ‬#
‫  ا‬+
‫ا‬
Distribution : pig eating countries
Mode : Ingestion of undercooked pork
C/P : allergeic manifestation , myositis, myocarditis ,fever
Investigations : muscle biopsy , complement , ELISA
TTT:albendazol , mebendazol , cortisone , brufen
----------------------------------------------------------------------------------------
filariasis ‫ت‬%
‫داء ا‬
bancrftian (elephantiasis )
loasis
onchocercosis
bancroftian filariasis ( elephantiasis ) D)
‫داء ا‬
Etiology :wuchereria bancrofti
Mode : mosquito bite
C/P : recurrent lymphangitis & adenitis , varicosities, elephantiasis
Investigations :midnight blood film , esinophilia , CFT
TTT: Ivermectin , Hetrazan, mebendazol, surgical

12
Loasis : ( African eye worm ) ‫ ا
 –داء ا
ا
ا‬%
‫ – ا‬49‫دودة ا
? ا‬
Etiology :loa loa
Mode : bite of deer fly ( cherysops ) ‫ال‬#8
‫ذﺏﺏ ا‬
Distribution : Africa, Nigeria
C/P : worm under conjunctiva -

conjunctivitis
Worm under skin --------

itchng

fugitive swelling around joints of extremities
Calaber swelling ---

Investigations :daytime blood film , , CFT , ELISA
TTT: , Hetrazan, cortisone , surgical
Onchocercosis, River blindness : I‫ﺏ ا
ﻥ‬6‫ى –داء آ‬A
‫ ا‬.
‫ا‬
Etiology :onchocerca volvulous
Mode : bite of black fly ( simuluim )
Distribution : tropical Africa, central America
C/P : onchocerca tumer , river blindness, elephantiasis
Investigations :aspiration of nodules , skin snips
TTT: suramin , Hetrazan , ivermectin , cortisone , surgical
--------------------------------------------------------------------------------------------------------
dracunculus medinensis -
‫ا
" ا‬medina worm – 
‫ ا‬%‫ﺥ‬
Etiology : dracunculus medinensis
Mode :drinking well water containing infected cyclops
C/P : erythema, vesicle , ulcer , generalized allergic manifestation
Investigations :gravid female under the skin , CFT
TTT: Extraction of worm , metronidazol , thiabendazol
--------------------------------------------------------------------------------------------------------
Hepatic flukes 
‫ ا
رت ا‬fascioliasis ‫ا
رت‬
Etiology : F hepatica & F gigantica 
‫ا
 –ا‬
Lives in bile ducts of sheep,cattle & man
Mode :ingesion of encysted metacercaria on acquatec vegetations
C/P : anemia, jaundice, cachexia,fever & esinophilia
Investigations : ova in stool ,IHA,CFT,CIE
TTT: Bithionol (Lorothidol, Bitin) , Triclabendazole (Fasinex) , praziquantil
--------------------------------------------------------
Intestinal flukes  
‫ا
رت ا‬
Etiology : fasciolopsis buski
Mode :same as above
Distribution : fare east
C/P : chronic diarrhea & malabsorption , allergic & toxic symptoms
Investigations : ova in stool
TTT: praziquantil
Hetrophys hetrophys ‫ا
)ﻥ ا
)ء‬
Etiology : H. hetrophys
Distribution : fare east , manzala Egypt
Mode : ingesion of encysted metacercaria with undercooked fish ( feseck )
C/P : abdominal pain & diarrhea
Investigations : ova in stool
TTT: praziquantil
--------------------------------------------------------
pulmonary flukes  
‫ا
رت ا‬
Etiology : paragonimus westermanni
Mode : ingesion of infected crebs
Distribution : fare east

13
C/P : chronic cough, hemoptysis, esinophilia, focal lesion in brain& spinal cord
Investigations : egg in sputum , CFT
TTT: praziquantil
-------------------------------------------------------------------------------------------------------------
SCHISTOSOMIASIS 7
‫ت ا‬+‫ﻡ‬
Etiology : S Mansoni , S. hematobium
Mode : contact with water canal
C/P : Anemia & abdominal pain , hepatomegaly
Portal hypertension ( varicosities, splenomegaly , ascites )
Dysuria ,hematuria, obustructive uropathy , bilharzial corpulmonal
Investigations : ovain urine & RBCS
TTT: praziquantil
-----------------------------------------------------------------------------------------------------
Taenia ‫ت‬%+
‫ا‬
Etiology : T saginata & T solium 
‫ء وا‬:#
‫ ا‬%+
‫ا‬
Mode : ingesion of undercooked beef & pigs
C/P : abdominal pain & diarrhea , intestinal obstruction , loss of weight , anaxiety
Investigations : egg in stool
TTT: yomesan/ once - praziquantil 15mg/kg/ once
Cysticecosis ‫آس ا
ﻥ‬9‫داء ا‬
Etiology : cysticercus cellulose ,larva of T. Solium
Mode : ingesion of eggs contaminating food & drink – autoinfection
Distribution : cosmopolitans
C/P :Brain -

epilepsy
Orbit
exophthalous
Skin
SC nodules
Muscles -

myositis
General --

fever & toxemia
Investigations : detection of cyst by XR , ultrasound , biopsy ,
CFT, IHA
TTT:,praziquantil 50mg/kg/day x 15days, albendazol x30days , cortisone, tegretol
------------------------------------------------
Hymenolepis Nana ‫ﻡ‬#
‫ء ا‬%8
‫ﻡ –ﻡ() ا‬#
‫ ا‬%+
‫ا‬
Etiology : H nana
Mode : ingesion of contaminated food & drink – autoinfection
C/P : enteritis , dizziness , anemia
Investigations : ova in stool
TTT: yomesan x 1wk - praziquantil 25mg/kg /once
----------------------------------------------------------
Diphylobothrium latum ‫ذات ا
)ﺕ? ا
 –ﻡ)رة ا
اس‬
Etiology : D latum ( dog tapeworm )
Mode : ingested incorrectly heated or frozen freshwater fish.
Distribution : Baltic countries
C/P : Megaloblastic anemia (pallor, breathlessness, and neurological symptoms such as weakness,
numbness, and disturbances in coordination.)
Investigations operculated eggs in the stool
TTT: praziquantil- yomesan
Hydatid disease  
‫ داء ا
ت ا‬Echinococcosis
Etiology : Echinococcus granulosus 
‫ ا‬M‫آ‬+
‫ا‬
Mode : handling infected dogs & cats – ingesion of eggs contaminating water & food
C/P : pressure atrophy of affected organs
Allergy ( asthma - esinophilia )

14
 Painless abdominal mass ( liver )
Cough & hemoptysis ( lung )
Pathologecal fractures ( bone )
Epilepsy & hemoplagia ( brain )
Investigations : ultrasonic , scann , xrays , casoni,.CFT,IHA,CIE,ELISA
TTT: albendazol , surgical
((Pharmacology ))
Antibiotics

15
 Penicillin
• First-Generation Penicillins :
• Penicillin G., Benzathine penicillin :
• (penicillinG 1million -retarpen 1.2 million
• Pneumococci, group A streptococci
• sensitive Streptococcus viridans, meningococci, Pasteurella (cat bites)
• Penicillin remains the drug of choice for meningococcal meningitis;
• Penicillin G is highly effective in subacute bacterial endocarditis
• Penicillin V.: similar to penicillin G , but less active against Gram-negative
bacteria, Neisseria gonorrhoeae and Haemophilus influenzae.
• Penicillinase-resistant penicillins : cloxacillin, flucloxacillin ,dicloxacillin used in
combinatiom with other drugs ( antistaph drugs )

Second-Generation Penicillins :
Ampicillin :
Active against pneumococci, , meningococci, gonococci and various streptococci

16
some H. influenzae , Salmonella, Shigella, Escherichia coli and Proteus
The drug of choice for meningitis caused by nonpenicillinase-producing strains of H. influenzae
Amoxicillin :
Same spectrum of ampicillin , better GIT absorption
less active against Shigella

Third-Generation Penicillins :
Carbenicillin ,carpoxypenicillin ,ticarcillin
Pseudomonas aeruginosa, Proteus and some strains of Enterobacter

Fourth-Generation Penicillins:
piperacillin and azlocillin
Klebsiella , many strains of Serratia. P. aeruginosa.
The newer cephalosporins and carbapenems appear to be preferable for treating infections caused
by resistant Klebsiella and Serratia strains.
• Penicillin/Beta-Lactamase Inhibitors :
Clavulanic acid, sulbactam (augmentin ,unasyn )
Moraxella catarrhalis , strains of H. influenzae, E. coli, Klebsiella
Some Proteus species and S. aureus ( except MRSA).
Gonococci, enterococci and many anaerobes
upper and lower respiratory tract infections
urinary tract infections, soft-tissue infections, sinusitis, and otitis media.
intra-abdominal infections and gynecologic infections

Cephalosporins
are structurally similar to penicillins.
The adverse effects are mainly local muscle pains (IM)
renal impairment and allergic reactions.
Pseudomembranous colitis has been reported.
activity against Gram-positive cocci diminishes from the first to the third generation, whereas the
spectrum of activity against Gram-negative organism increases.
the third generation cephalosporins display good cerebrospinal fluid activity
None of the first-generation drugs is effective in meningitis.

First-Generation Cephalosporins :
Cephalexin (keflex,ceporex )
Cephradine (velosef )
Cefadroxil (duricef,biodroxil )
Cefazolin (totacef ) has a relative lack of pain on IM and higher blood concentration
S. aureus;(exceptMRSA)many strains of E.coli,K.pneumoniae and P. mirabilis
UTI , soft tissue infection

Second-Generation Cephalosporins :
have extended activity against Gram--ve bacteria but are less active against Gram-+ve
oral form are more effective than the first generation in the treatment of otitis media and
bronchitis caused by H. influenzae.
Cefoxitin.:
Active against Gram-+ve&-ve anaerobes
Used in the management of abdominal and pelvic infections.
Cefuroxime (zinnat ):
H. influenzae , pneumococci and meningococci

17
effective as ampicillin plus chloramphenicol in pneumonia and childhood meningitis caused by H.
influenzae, pneumococci and meningococci.
These potential advantages, however, are shared by the third-generation cephalosporins
Cefprozil, loracarbef and cefaclor:
have similar activities but exhibit increased activity against H. influenzae and M. catarrhalis.

Third-Generation Cephalosporins :
Pass blood brain barrier ( except cefoperasone)
Active against Ecoli,Klebsiela,proteus,serratia,citrobacter,H influ,Gonococci,salmonella
Inactive against enterococci,MRSA,Listeria
Less active against G+ve cocci
The drug of choice for G-ve bacillary meningitis
Cefotaxime : is effective in the treatment of pneumococcal meningitis, pneumonias and
bacteremias caused by pneumococci and methicillin-sensitive S. aureus.
Ceftriaxone. It is highly active against enteric Gram-negative bacilli, Neisseria, Salmonella and
Haemophilus species
less active against B. fragilis and P. aeruginosa.
treatment of bacterial meningitis in children.
used for single-dose treatment of gonorrhea
Ceftriaxone-induced cholelithiasis
Cefoperazone : is less active against enteric Gram-negative bacilli than the others
Active against P. aeruginosa, but ceftazidime and cefepime are the greatest
Ceftazidime: has the greatest activity against P. aeruginosa among the cephalosporins.
Ceftazidime-aminoglycoside combination therapy has been effective in neutropenic cancer
patients with Gram-negative bacteremia.
Cefepime : effective against P. aeruginosa as ceftazidime
Active against pneumococci (including penicillin B resistant strains) and methicillin-sensitive S.
aureus as cefotaxime and ceftriaxone and is more active against Enterobacter, Proteus,
Citrobacter and Serratia.
effective as monotherapy in febrile neutropenic patients.
Cefixime : more active than other oral cephalosporins against E. coli, Klebsiella, P. mirabilis and
Serratia
very active against H. influenzae, N. gonorrhoeae and M. catarrhalis.
Inactive against anaerobes, Pseudomonas and Enterobacter.
It is administered in a single daily dose.
Cefpodoxime :similar to cefixime except for its greater activity against methicillin-sensitive S.
aureus.

Carbapenems
Imipenem (tienem)has the broadest antibacterial spectrum of any beta-lactam antibiotic and is
active against Gram-negative bacteria.
Synergism can be demonstrated between imipenem and amikacin against some strains of
Pseudomonas.
used successfully in patients with pneumonia, intra-abdominal infections, urinary tract infections,
endocarditis, bacteremia, osteomyelitis and cellulitis and for treating infections in neutropenic
cancer patients.
Side effect : Nausea and vomiting, local pain at injection sites, and hypersensitivity
Meropenem,(meronem): a second carbapenem, is similar to imipenem
The drug has been used successfully in children with meningitis caused by meropenem-sensitive
organisms

18
 Monobactams
aztreonam ( azactam )is restricted to aerobic Gram-negative bacteria.
Most strains of H. influenzae, cocci and meningeal cocci are susceptible
most enteric Gram-negative bacilli, including E. coli, Klebsiella, Proteus and Enterobacter. Most
strains of P. aeruginosa are also susceptible
the drug is widely distributed in body tissues and fluids, including the CSF
Excellent blood levels are achieved after intramuscular or intravenous administration,
used in the treatment of a wide range of infections caused by Gram-negative bacteria, including
pneumonias, skin and soft tissue infections, bone and joint infections, urinary tract infections and
bacteremias.
It may replace aminoglycosides in many Gram-negative infections.
Side effect : enterococcal superinfections. , local reactions at the site of injection, rash, diarrhea,
nausea and vomiting.

Aminoglycosides
Streptomycin
Its use is restricted principally to three situations:
The initial treatment of serious tuberculosis infections
The treatment of enterococcal infection
The treatment of uncommon infections, such as bubonic plague and tularemia
Side effect : vestibular damage during prolonged treatment

Gentamicin :
active against P. aeruginosa as well as the Gram--ve bacilli
Gentamicin penetrates pleural, ascitic and synovial fluids in the presence of inflammation, but
diffuses poorly into CSF or respiratory secretions.
checked frequently for vestibular or auditory dysfunction
Tobramycin :
similar to gentamicin, but it is more active against P. aeruginosa.
Like gentamicin, tobramycin act synergistically with ticarcillin against P. aeruginosa.

Amikacin :
similar spectrum to gentamicin.
The principal use of amikacin is the treatment of infections caused by gentamicin or tobramycin
resistant Gram-negative bacilli.
It is also used in as the initial treatment of presumed Gram-negative bacillary bacteremia in
compromise host when a gentamicin resistant organism is suspected in a specific institution.
Side effect : ototoxicity and nephrotoxicity.
Netilmicin :
It is pharmacologically similar to gentamicin.
less active against P. aeruginosa.
It is generally used only for organisms resistant to other aminoglycosides.

Tetracyclines

19
Active against both Gram-positive and Gram-negative bacteria.
Tetracyclines are the drug of choice in the treatment of Rocky Mountain spotted fever and other
rickettsioses.
They are useful in the treatment of pneumonia caused by M. pneumoniae or Chlamydia
pneumoniae, urogenital infections caused by Chlamydia trachomatis and other chlamydial
diseases such as psittacosis, trachoma and lymphogranuloma venereum.
Other indications include brucellosis, plague, cholera, granuloma inguinale and Lyme Used in
treatment of syphilis in patients allergic to penicillin.
Tetracyclines are used as adjuvant therapy in the treatment of severe cystic acne.
Concomitant ingestion of milk and antacids impairs tetracycline absorption.
Tetracyclines should not be given to children younger than 9 years or to pregnant women, because
it may result in permanent discoloration of teeth.

Doxycycline :
long-acting tetracyclines admintration every 12 to 24 hours
The drug of choice in a patient with renal insufficiency
has been found to be useful in the prophylaxis of traveler’s diarrhea.

Macrolides
Erythromycin
remains active against M. pneumoniae, C. trachomatis and some Gram-negative bacilli including
Legionella pneumophila, Campylobacter, Flavobacterium and Bordetella pertussis. Neisseria and
Treponema pallidum and occasional strains of atypical mycobacteria. M cataralis
it is used to treat syphilis in pregnant women allergic to penicillin.
In patients who cannot tolerate penicillins and cephalosporins, erythromycin is an effective
alternative for the treatment of streptococcal pharyngitis, bronchitis, pneumonia and infections of
skin and soft tissue.
Other uses include granuloma inguinale, chancroid (administered with a sulfonamide), acne (oral
or topical preparations)
Gastrointestinal intolerance is the most common side effects.
Up to 37% of patients receiving erythromycin intravenously experience nausea, sometimes with
vomiting, that is severe enough to interrupt therapy.

20
Clarithromycin ( klacid )
Highly active against those organisms that are sensitive to erythromycin.
used successfully for the treatment of sinusitis, pharyngitis, bronchitis, and pneumonia caused by
susceptible organisms.
Mycobacterium avium-complex (MAC) infections in patients with AIDS
Helicobacter pylori gastric infections.
Well absorbed from GIT not affected by food

Azithromycin (Zithromax)
have similar spectrums of clarithromycin
It is also active against C. trachomatis, C. pneumoniae, Haemophilus ducreyi and some anaerobes
Treatment of the streptococcal pharyngitis, sinusitis, bronchitis and pneumonia, and skin and soft
tissue infections.
Used as a single-dose therapy for urethritis and cervicitis caused by C. trachomatis.
Treatment of chronic infections, such as MAC and Toxoplasma in patients with AIDS.
Affected by food should be taken after 2hours of food
Therapeutic range remains from 4 to 7 days after the five-day treatment course.

Dirithromycin :
similar to erythromycin active against M. catarrhalis,
it is not active against H. influenzae.
it can be administered once daily.
The drug produces similar gastrointestinal side effects as erythromycin

Therapy for ascaris

Anthelmintics - Vermifuges -- DOC for infection that does not produce symptoms. Does not cause
paralysis of worms.

Mebendazole (Vermox) -- Causes worm death by

selectively and irreversibly blocking uptake of
Drug Name
glucose and other nutrients of. Administration
over 3 d reduces risk of worm bolus formation.
Adult Dose 100 mg PO bid for 3 d
<2 years: Do not administer
Pediatric Dose
>2 years: Administer as in adults
Contraindications Documented hypersensitivity
Carbamazepine and phenytoin may decrease
Interactions effects of mebendazole; cimetidine may increase
mebendazole levels
C - Safety for use during pregnancy has not been
Pregnancy
established.
Has not been studied extensively in children <2 y
Precautions (consider risks vs benefits for use in this age
group); adjust dose in hepatic impairment

Systemic anthelmintic agents- -- Alternative therapy for Ascaris species infection.

21
 Albendazole (vermizol) -- Broad-spectrum
anthelmintic agent effective against Ascaris
species, hookworm, tapeworm, liver fluke, and
Drug Name
pinworms. Decreases ATP production in worm,
causing energy depletion, immobilization, and
finally death.
Adult Dose 400 mg PO as a single dose; may repeat in 3 wk
<2 years: 200 mg PO as a single dose; may repeat
Pediatric Dose in 3 wk
>2 years: Administer as in adults
Contraindications Documented hypersensitivity
Carbamazepine may accelerate albendazole
metabolism; dexamethasone increases plasma
levels of albendazole metabolites; praziquantel
Interactions
may increase albendazole plasma concentrations;
fatty foods may increase bioavailability of
albendazole up to 4-5 times
C - Safety for use during pregnancy has not been
Pregnancy
established.
Discontinue if LFT enzymes rise; may restart
Precautions when LFTs are at baseline levels; not advised
during pregnancy if avoidable

Therapy for ancylostoma

Albendazole (vermizol) In children, albendazole
appears superior to mebendazole for curing
Drug Name hookworm infestations (cure rates of ~90% for
Ancylostoma and 75% for Necator using
albendazole).
For classic hookworm disease and eosinophilic
Adult Dose enteritis: 400 mg PO once
For cutaneous larva migrans: 400 mg PO qd for 3 d
<6 years: Not established
Pediatric Dose
>6 years: Administer as in adults
Contraindications Documented hypersensitivity
Coadministration with carbamazepine may decrease
Interactions efficacy; dexamethasone, cimetidine, and
praziquantel may increase toxicity
C - Safety for use during pregnancy has not been
Pregnancy
established.
Information based on use to treat patients with
hydatid disease and neurocysticercosis, for which the
drug is used for prolonged periods (8-30 d for
neurocysticercosis and 3 mo for hydatid disease);
Precautions embryotoxic and teratogenic in pregnant rats and
rabbits; no adequate studies in pregnant women, but
no deleterious effects were recorded among 10 cases
of women who were exposed accidentally to high
doses of albendazole for systemic infection during

22
 first trimester and followed to term; excreted in
animal milk; whether excreted in human milk
unknown
Patients with abnormal liver function tests (LFTs)
should be carefully evaluated before commencing
therapy because drug metabolized in liver and
associated with hepatotoxicity; most common adverse
effect is reversible increase in serum
aminotransferases (16%); abdominal pain, diarrhea,
nausea, dizziness, and headache occasionally occur
(just above 1%); causes reversible reductions in total
WBC count in <1% of patients
Mebendazole (Vermox) -- Recommended for
treatment of eosinophilic enteritis; inhibits
microtubule polymerization by binding to
cytoplasmic β-tubulin; by affecting parasite's
intestinal cells, prevents use of nutrients and
essentially starves parasite to death; dosage shown is
selectively toxic to parasites because binding to
parasite β-tubulin occurs at much lower concentration
Drug Name
than binding to mammalian protein; because drug acts
locally on worms within GI tract, action not dictated
by systemic drug concentration.
A repeat stool examination using a concentration
technique is recommended after 2 wk, and
retreatment is indicated if results are positive. No
fasting or purging is required. Tab may be chewed,
swallowed, or crushed and mixed with food.
100 mg PO bid for 3 d or 500 mg PO once (some
Adult Dose studies show better cure rates using multidose
regimen)
<2 years: Not established
Pediatric Dose
>2 years: Administer as in adults
Contraindications Documented hypersensitivity
Carbamazepine and phenytoin may decrease effects;
Interactions
cimetidine may increase levels
C - Safety for use during pregnancy has not been
Pregnancy
established.
Found to be embryotoxic and teratogenic in pregnant
rats at single PO doses as low as 10 mg/kg
(approximately equal to the human dose, based on
mg/m2); on the basis of these findings, not
recommended in pregnant women, especially in first
trimester; no adequate studies of administration in
Precautions pregnant women, although postmarketing studies in
170 pregnant women who had inadvertently taken the
drug did not reveal higher than usual incidence of
spontaneous abortions or malformations; not known
whether mebendazole is excreted in human milk;
therapy may not eradicate dormant larvae residing in
extraintestinal tissues because drug is poorly absorbed

23
 into systemic circulation
Abdominal pain and diarrhea may occur in massive
infections and expulsion of GI worms; rare reports of
neutropenia and agranulocytosis when used for
prolonged periods and at higher than recommended
doses; elevated liver enzymes and, rarely, hepatitis
occur when mebendazole used for prolonged periods
and administered in dosages substantially above those
recommended
Pyrantel (Reese's Pinworm Medicine, Antiminth) --
FDA approved but considered investigational for this
Drug Name condition; depolarizing neuromuscular blocking agent
that inhibits cholinesterases, resulting in spastic
paralysis of the worm.
11 mg/kg (5 mg/lb) PO for 3 d, not to exceed 1 g,
Adult Dose
without regard to ingestion of food or time of day
<2 years: Not established
Pediatric Dose
>2 years: Administer as in adults
Contraindications Documented hypersensitivity; hepatic disease
In ascariasis, pyrantel and piperazine are mutually
antagonistic and should not be used concomitantly;
Interactions
theophylline serum levels may increase in pediatric
patients, following pyrantel pamoate administration
Pregnancy D - Unsafe in pregnancy
Caution in liver impairment, anemia, and
Precautions malnutrition; transient GI symptoms, headache, and
dizziness occasionally observed
Thiabendazole (Mintezol) -- FDA approved but
considered investigational for this condition;
indicated only for cutaneous larva migrans; inhibits
microtubule polymerization by binding to
cytoplasmic beta-tubulin; by affecting intestinal cells
of parasite, prevents use of nutrients, essentially
Drug Name starving parasite to death.
Dosage shown is selectively toxic to parasites because
binding to parasite beta-tubulin occurs at a much
lower concentration than binding to mammalian
protein.
Administer PO dose pc; tabs should be chewed before
swallowing.
Topical administration (for cutaneous larva migrans):
Apply 10-15% susp to lesions 4-6 times daily for 2-5
Adult Dose d
PO: 25 mg/kg/dose bid for 2-5 d; not to exceed 1.5
g/dose
<30 lb: Not established
Pediatric Dose
>30 lb: Administer as in adults
Contraindications Documented hypersensitivity
May elevate serum levels of theophylline, increasing
Interactions
toxicity (monitor serum levels and reduce dose prn)

24
 C - Safety for use during pregnancy has not been
Pregnancy
established.
Closely monitor in hepatic or renal dysfunction;
before initiating therapy, supportive therapy
necessary for anemic, dehydrated, or malnourished
patients; use in confirmed worm infestation, not
prophylactically; may cause nausea, vomiting, and
mild CNS depression; associated with erythema
Precautions
multiforme, including Stevens-Johnson syndrome;
animal studies reveal no teratogenic effects; no
adequate studies in pregnant women; whether
excreted in human milk unknown; potentially serious
adverse reactions in infants requires decision whether
to discontinue breastfeeding or thiabendazole
Ivermectin (Stromectol, Mectizan) -- FDA approved
but considered investigational for this condition;
recommended for treatment of cutaneous larva
Drug Name
migrans; binds selectively with glutamate-gated
chloride ion channels in invertebrate nerve and
muscle cells, causing cell death.
Adult Dose 200 mcg/kg/d PO for 1-2 d
<5 years: Not established
Pediatric Dose
>5 years: Administer as in adults
Contraindications Documented hypersensitivity
May interact with other ligand-gated chloride
Interactions
channels (eg, those gated by GABA)
C - Safety for use during pregnancy has not been
Pregnancy
established.
Treat mothers who intend to breastfeed only when
risk of delayed treatment outweighs possible risks to
newborn caused by ivermectin excretion in milk;
Precautions repeat courses of therapy may be required in patients
who are immunocompromised; may cause
drowsiness, nausea, vomiting, and mild CNS
depression

Amebic Meningoencephalitis
Amphotericin B (Amphocin, Fungizone) --
Amebicidal at low levels. Basis of therapy for all
PAM survivors and used for GAE; remains DOC for
both in absence of further studies. Although few data
Drug Name
exist, use of 1 of the lipid formulations at maximum
doses is recommended because higher doses can be
delivered with theoretically less toxicity (see
Amphotericin B lipid complex).
Intravenous: 1-1.5 mg/kg/d IV
Adult Dose Intrathecal: 25-100 mcg IT q48-72h; may increase to
500 mcg IT as tolerated
Pediatric Dose Administer as in adults

25
Contraindications Documented hypersensitivity
Antineoplastic agents may enhance potential of
amphotericin B for renal toxicity, bronchospasm, and
Interactions hypotension; corticosteroids, digitalis, and thiazides
may potentiate hypokalemia; risk of renal toxicity is
increased with cyclosporine
Pregnancy B - Usually safe but benefits must outweigh the risks.
Monitor renal, hepatic, electrolyte, and hematologic
status closely; hypercalciuria, hypokalemia,
hypomagnesemia, renal tubular acidosis, renal failure,
acute hepatic failure, hypotension, and phlebitis;
common infusion-related reactions include fever,
chills, headache, hypotension, nausea, and vomiting;
may premedicate with acetaminophen and
diphenhydramine 30 min before and 4 h after
Precautions
infusion; meperidine may be useful for chills;
hydrocortisone 1 mg/kg (not to exceed 25 mg) may be
added to amphotericin B IV bottle, may help prevent
immediate adverse reactions; hydrate with 10-15
mL/kg of 0.9% NaCl infused before each dose to
minimize risk of nephrotoxicity; consider adjunctive
measures as patient's condition tolerates; adjust dose
in renal failure

Cryptosporidiosis
Bismuth subsalicylate (Pepto-Bismol) -- Exerts
Drug Name antisecretory and antimicrobial effects to control
diarrhea.
2 tabs or 30 mL PO q30 min to q1h prn; not to
Adult Dose
exceed 8 doses/d
<3 years: Not established
3-5 years: 87 (5 mL) PO q30min to q1h prn; not
to exceed 700 mg/d (8 doses/d)
6-9 years: 175 mg (10 mL) PO q30min to q1h
Pediatric Dose
prn; not to exceed 1400 mg/d (8 doses/d)
10-12 years: 262 mg (15 mL) PO q30min to q1h
prn; not to exceed 2100 mg/d (8 doses/d)
>12 years: Administer as in adults
Documented hypersensitivity; because of
Contraindications association of aspirin with Reye syndrome, do
not use in children (<16 y) with flu
Coadministration with anticoagulants may
increase risk of bleeding; may increase toxicity of
Interactions
aspirin and hypoglycemics; decreases effects of
tetracyclines and uricosurics
C - Safety for use during pregnancy has not
Pregnancy
been established.
May cause temporary and harmless darkening of
Precautions
tongue and/or black stool; alcohol consumption

26
 may cause abdominal cramps, nausea, and
vomiting
Attapulgite (Kaopectate, Diasorb) -- Adsorbent
Drug Name
and protectant that controls diarrhea.
1200-1500 mg PO after each loose bowel
Adult Dose
movement; not to exceed 7 doses/d or 9 g/d
<3 years: Not recommended
3-5 years: 150 mg PO after each loose bowel
movement; not to exceed 7 doses/d
Pediatric Dose
6-12 years: 300 mg PO after each loose bowel
movement; not to exceed 7 doses/d
>12 years: Administer as in adults
Contraindications Documented hypersensitivity
Decreases absorption of digoxin, clindamycin,
Interactions
tetracyclines, and penicillamine
B - Usually safe but benefits must outweigh the
Pregnancy
risks.
Caution in patients >60 y; avoid in presence of
Precautions high fever; at high doses, may cause
constipation

Bancroftian Filariasis
Ivermectin (Mectizan, Stromectol) -- Exerts its
antiparasitic action by acting as a potent agonist at
gamma-butyric acid (GABA) receptors and
potentiating the inhibitory signals sent to motor
neurons that paralyze the parasite. Because GABA is
confined to the CNS in humans and ivermectin does
Drug Name
not cross the blood-brain barrier, the drug has no
paralytic action in humans. Mechanism of action is
thought to involve GABA pathways and chloride ion
channel permeability. Potent microfilaricide and
macrofilaricidal for W bancrofti in multiple doses.
Used alone or in combination with DEC.
150-200 mcg/kg of body weight PO as a single dose,
Adult Dose
repeat at 2-3 monthly intervals
<5 years or <15 kg (33 lb): Do not administer
Pediatric Dose
>5 years: Administer as in adults
Contraindications Documented hypersensitivity; concurrent illness
May interact with other ligand-gated chloride
Interactions
channels, such as those gated by GABA
C - Safety for use during pregnancy has not been
Pregnancy
established.
Although inadvertent use in pregnancy has not been
associated with an increased number of birth defects,
Precautions avoid while pregnant, if possible; treat mothers who
intend to breastfeed only when risk of delayed
treatment outweighs possible risks to the newborn

27
 caused by ivermectin excretion in milk; may cause
nausea, vomiting, and mild CNS depression; may
cause drowsiness
Diethylcarbamazine (Hetrazan) -- Has been shown to
induce immobilization of microfilariae by decreasing
muscle activity due to hyperpolarization effects, but
the precise mechanism of DEC is not understood.
Alteration of the surface membrane also occurs, with
enhanced destruction by the host's immune system.
Drug Name
Evidence also exists that DEC may enhance adhesion
of granulocytes via antibody-dependent and antibody-
independent mechanisms. Interference by
microfilarial intracellular processing and transport of
specific macromolecules by DEC has also been
hypothesized.
6 mg/kg of body weight PO qd for at least 12 d,
preferably 3 wk; low doses (approximately 2-3
Adult Dose
mg/kg/d) usually recommended for first 3 d of
treatment to decrease risk of adverse effects
Pediatric Dose Administer as in adults
Documented hypersensitivity; DEC provocation
(provocation of microfilariae for bancroftian filariasis
Contraindications is contraindicated in areas where Loa loa and
Onchocerca volvulus are endemic because of risk of
severe Mazzotti reaction)
Interactions None reported
Pregnancy B - Usually safe but benefits must outweigh the risks.
Nonteratogenic and safe in pregnancy but
spontaneous abortion or premature labor and delivery
are possible with induced febrile reactions; DEC
provocation; caution in individuals with potentially
heavy infections of lymphatic filariids because a DEC
dose of 2 mg/kg of body weight may provoke febrile
Precautions
and inflammatory reaction secondary to worm death;
antipyretics and steroids may decrease risk of these
symptoms; possible allergic reactions of fever,
urticaria, and lymphangitis in lymphatic filariasis;
nonspecific adverse effects include headache,
malaise, nausea, vertigo, and vomiting
Albendazole (Albenza, Eskazole, Zentel) -- Methyl
[5-(propylthio)-1H-benzimidazol-2yl] carbamate. A
broad-spectrum anthelminthic. Action is thought to be
Drug Name mainly intraintestinal, although at higher doses a
sufficient amount is absorbed and metabolized to an
active sulfoxide metabolite to have a therapeutic
effect against tissue parasites.
Adult Dose 400 mg PO as a single dose
Pediatric Dose Administer as in adults
Documented hypersensitivity; pregnancy or
Contraindications
possibility of pregnancy

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 Coadministration with carbamazepine may decrease
Interactions efficacy; dexamethasone, cimetidine, and
praziquantel may increase toxicity
Pregnancy D - Unsafe in pregnancy
Mild-to-moderate elevations of liver enzymes
reported, especially with high-dose regimens; liver
enzymes usually normalize on discontinuation of
treatment; rare reports of severe hepatic abnormalities
associated with jaundice and histological
Precautions
hepatocellular damage, possibly irreversible; has been
shown to be teratogenic and embryotoxic in rats and
rabbits; advise women of childbearing age to take
effective precautions against conception during and
within 1 mo of completion of treatment

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‫ ا‬.$‫ أ&)ل وﺡ‬. '‫ ز أﺥ‬7‫ اﺏاه‬7‫ ﻡ اﺏاه‬/‫اد د‬N‫إ‬
* R4‫ﻡ‬

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