PHARMACOTHERAPY on

TROPICAL DISEASES
Sulanto Saleh-Danu r.,dr., SpFK.

Dept.of Pharmacology & Therapy
Clinical Pharmacology Division,
Faculty of Medicine, UGM.
R
R
BLOCK 22
1
Whats
tropical
diseases ??????
2
diseases
AREA-CLIMATE ABNORMLITY BY
CAUSATIVE AGENTS
TROPIC
SUBTROPIC
4-SEASON
COUNTRIES
ARTIC/ANTARTIC
GENETIC
DEGENERATIVE
METABOLISM
MALIGNANCY
INFECTION
OTHERS
PARASITES
FUNGAL
BACTERIAL
VIRAL
3
MAYOR TROPICAL
INFECTIONS.

1. MALARIA
2. VISCERAL LEISHMANIASIS
3. CUTANEUS LEISHMANIASIS
4. TUBERCULOSIS
5. HIV INFECTION and
DISEASES IN THE TROPICS
6. FILARIASIS and
ONCHOCERCIASIS
7. AFRICAN TRYPANOSOMIASIS
8. SOUTH AMERICAN TRYPANO-
SOMIASIS (CHAGAS DISEASES)
9 SCHISTOSOMIASIS
10. LEPROSY

OTHERS:

Gasterointestinal.
1. Amoebiasis
2. Bacillary Dysentery
3. Cholera
4. Giardiasis and others protozoa infect.
5. Intetstinal cestoda infect. (tapeworm)
6. Soil-transmitted Helminths
7. Viral Hepatitis
8. Liver Flukes
9. Hydatid disease

Respiratory.
1. Pneumonia
2. Lung Flukes
3. Tropical Pulmonary Eosinophilia

Neurological
1. Pyogenic meningitis
2. Cryptococcal meningitis
3. Encephalitis
4. Acute Flaccid Paralysis
5. Spastic paralysis
6. Rabies
7. Tetanus
4
Fever.
1. Brucellosis
2. Typhoid and Paratyphoid Fever
3. Arbovirusis
4. Viral Haemorrhagic Fever
5. Dengue and Yellow Fever
6. Relapsing Fever
7. Rickettsial Infections
8. Leptospirosis
9. Melioidosis

Miscellaneous.
1. Tropical Ulcer
2. Buruli Ulcer
3. Myasis
4. Cutaneous Larva Migrans
5. Scabies and Lice
6. Strongyloides stercoralis
7. Guinea Worm Infection
(Dracunculiasis)
8. Histoplasmosis
9. Other Fungal Infections
10. Haemoglobinopathies and
Red Cell Enzymopathies
11. Haematinic Defficiencies
12. Bites and Stings
13. Non-Communicable Diseases
14. Refugee Health

(Gill and Beeching, 2004)
5
OTHERS
CAUSATIVE AGENTS
PARASITES
FUNGAL
BACTERIAL
VIRAL
TROPIC
10s - the most common
diseases
1. MALARIA
2. VISCERAL LEISHMANIASIS
3. CUTANEUS LEISHMANIASIS
4. TUBERCULOSIS
5. HIV INFECTION and
DISESEASE IN THE
TROPICS
6. FILARIASIS and
ONCHOCERCIASIS
7. AFRICAN
TRYPANOSOMIASIS
8. SOUTH AMERICAN
TRYPANO-
SOMIASIS (CHAGAS
DISEASES)
9 SCHISTOSOMIASIS
10. LEPROSY









- ANAMNESTIC
-PHYSIC
EXAMINATION
-LABORATORY
: -Blood
-Urine
-Stool
-Others
-RADIOLOGY:
-USG
-X-ray
-Others









SIGN &
SYMPT.
Diagnose/
DD
Prog. &
Complic.
TREATMENT
6
NON PHARMACO-
THERAPIES
PHARMACOTHERAPEUTICS
SELECTION OF MEDICINES

ROUTE OF
ADMINISTRATION

DOSAGE FORM

FREQUENY

DURATION

ADVERSE DRUG REACTION

INTERACTION
7
EFFICACY
SAFETY
COSTLY
TREATMENT
HOST
MICRO-
ORGANISM /
PARASIT
INVASIVE
PHARMACOTHERAPY
KILLED & DESTROYED
SAFE
PHARMACOTHERAPY
should be :
PREVENTIVE
IMMUNIZATION
8
PHARMACOKINETIC
PHARMACODYNAMIC
BODYWEIGHT
NUTRIONAL STATUS &
DIETARY HABITS
TROPICAL ENVIRONMENT:
-climatic factors
-infections and infestations
-environment pollutants
(chemicals, mycotoxins, alcoholism,
smoking, etc)
DRUG DOSAGE,
ABSORPTION,
DISTRIBUTION,
METABOLISM,
EXCRETION
TROPIC- COUNTRIES
SITUATION
EFFECTS,
RESPONSES,
INTERACTIONS,
ADVERSE EFFECTS,
Etc., etc.
PHARMACOTHERAPY
9
DRUGS NUTRIONAL STATUS/ EFFECT ON DRUG % CHANGE
CONDITION CLEARENCE
-Phenazone undernutrition increased 6
nutritional oedema decreased 21
low protein diet decreased 32
high protein diet increased 46
charcoal broiled beef increased 38

Propranolol high protein diet increased 60
high karbohydrate diet decreased 37

Tetracycline undernutrition increased 60
nutritional oedema decreased 43

Sulfadiazine undernutrition Increased 41

Rifampisin undernutrition increased 63

Chloroquine undernutrition increased 60

Phenylbutazone undernutrition increased 62

Theophylline high protein diet increased 28
low protein diet decreased 22
charcoal broiled beef increased 32

10
KINETIK
FACTORS DRUG USE PROBLEMS
IN TROPICAL ENVIRONMENT
Drug consumption in tropical countries
Per capita income
Available health services:
drug distribution between
rural-urban; self-medication
Disease pattern
Economic and
education level
Drug production & distribution
Cost of medicine
Inter-related factors in drug consumption pattern. (Krishnaswamy,K., 1997)
11

PHARMACOKINETIC:
- absorption of drug
- distribution in the body
- metabolism of the drug
- excretion / elimination

Drug concentration in the body
Drug receptor
interaction
Respones
PHARMACODYNAMIC
PHARMACOTHERAPY OUTCOME
12
Free drug
HOST
MICRO-
ORGANISM /
PARASIT
INVASIVE
KILLED & DESTROYED
SAFE
PHARMACOTHERAPY
should be :
PREVENTIVE
IMMUNIZATION
13
14
MICROORGANISM / PARASITE
TARGETS OF CHEMOTHERAPY

1. UNIQUE ENZYMES ONLY IN THE PARASITE

2. ENZYMES FOUND IN BOTH HOST & PARASITE
BUT INDISPENSABLE ONLY FOR THE PARASITE

3. COMMON BIOCHEMICAL FUNCTION FOUND
IN BOTH PARASITE & HOST, BUT WITH DIFFERENT
PHARMACOLOGIC PROPERTIES

15
1. UNIQUE ENZYMES
-Enzymes for dihydropteroate Apicomplexa Sulfones and Sulfonamides
syntesis

-Glycolipid synthesis African trypanosmes None

-Pyruvate:ferrodoxin oxidoreductase Anaerobic protozoa Nitroimidazole

-Pyruvate phosphate kinase Anaerobic protozoa None

-Nucleoside phosphotranferase Flagellated protozoa Allopurinol riboside and
formycine B

-Trypanothione reductase and Kinetoplastida Nifurtimox
peroxidase
ENZYMES PARASITES INHIBITORS
16
2. INDISPENSABLE ENZYMES
ENZYMES PARASITES INHIBITORS
Lanosterol C-14 demethylase Leishmania & Trypanosoma cruzii Azoles

Purine phosphoribocyl transferase Protozoa Allopurinol

Purine nucleoside kinase Trichomonas vaginalis and None
Entamoeba hystolytica

Ornitine decarboxylase African Trypanosomes -Difluoroethylornithine

(S)-Adenosylmethionine African trypanosomes Diamidines
decarboxylase

Glycolytic enzymes Kineplastida Glycerol plus salicyl-
hydroxamic acid and
suramine

17
3. INDISPENSABLE BIOCHEMICAL FUNCTION
WITH DIFFERENT PHARMACOLOGIC PROPERTIES
ENZYMES PARASITES INHIBITORS
Dihydrofolate reductase-thymidylate Apicomplexa and Kineto- Pyrimethamine
synthase bifunctional enzyme plastida

Thiamine transporter Coccidia Amprolium

Mitochondrial electron transporter Apicomplexa 4-Hydroxyquinolines
and
2-hydroxynaphthoquinones

Microtubules Helminth Benzimidazoles

Nervous synaptic transmission Helminth and Levamisole, piperazine,
ectoparasite the milbemycins, and
the avermectine
Pharmacotherapy on Tropical Diseases
PARASITIC INFECTIONS
1. Malaria
2. Filariasis
3. Onchocerciasis
4. Schistosomiasis
5. Leishmaniasis
6. African Trypanosomiasis
(Sleeping Sickness)
7. American Trypanosomiasis
(Chagas Disease)
8. Amoebiasis
BACTERIAL INFECTIONS
9. Leprosy
10.Tuberculosis
VIRAL INFECTION.
11. Dengue
12. HIV

R
EFFICACY

SAFETY

ECONOMIC

AVAILABILLITY

AFFORDABILLITY
18
1. MALARIA
- The most important tropical disease, affecting over 2200 million, more than
2 million deaths/year.
- Cause : PLASMODIUM : - P. VIVAX
- P. OVALE
- P. MALARIAE
- P. FALCIPARUM severity deaths
-COMPLICATION : 1. cerebral malaria
2. hyperpyrexia
3. hemolytic anemia
4. noncardiogenic pulmonary edema
5. acute tubular necrosis & renal failure
6. acute hepatopathy
7. hypoglycaemia
8. cardiac dysrhytmias
9. gastrointestinal syndromes
10. lactic acidosis
11. water and electrolyt imbalance

19
MALARIA

Drug classification ( by chemical based ):

4-aminoquinolines : chloroquine; hydroxychloroquine; amodiaquine
8-aminoquinolines : primaquine
diaminopyrimidines : pyrimethamine; trimethoprim
biguanides
(folate antagonist) : proguanil; chlorguanide; chlorproguanil
quinoline methanol : quinine; quinidine, mefloquine
sulfonamides : sulfadoxine; sulfadiazine; sulfamethoxazole
folate antagonist combination :
sulfadoxin pyrimethamine (Fansidar ),
chloroguanil - dapsone
tetracycline : doxycycline, clindamycin
phenanthrene methanol : halofantrine; atovaquone
sesquiterpene lactone
endoperoxiodes : artemisinins (qinghaosu), artesunate, artemether
quinone-folate antagonist
combination : atovquone-proguanil (Malarone)
amyl alcohol : lumefantrine

20
MALARIA

Classification based on the drug actions.
Tissues schizonticides : inhibit the growth of pre-erythrocyt
stage of parasite (liver) proguanil; primaquine; pyrimethamine
(with or without sulfonamides) causal prophylactics
Antirelaps drugs : kill the dormant hypnozoites primaquine;
8-aminoquinolones indicated P.vivax & P ovale
Blood schizonticides : kill the erythrocytic form, chloroquine;
quinine; mefloquine can be used as suppressive prophylactics
Gametocytocides : destroy the asexual stage of the parasite in the
blood primaquine
Sporozonticides : inhibit formation of oocyst and sporozoites in
mosquitoes pyrimethamine; proguanil

Next: 3 examples of anti-malaria drugs profiles.
21
CHLOROQUINE
MECHANISM OF ACTION : forms a toxic complex with ferriprotoporphyrine IX
(haeme), class of blood schizontocide and gametocide.
Plasmodium sensitive : P. vivax, falciparum, ovale, malariae.
Onset of drug effects : 3 hours.

PHARMACOKINETIC PROFILE : ROUTE OF ADMINSTR.:
F (%) : 90 Oral; Parenteral
t (h) : 1220 (41-50 ds) DOSAGE : 600 mg initially,
Vd (L) : 57.400 6-8 h later : 300 mg
CL (L/h) : 65 and next 2 days 300 mg
Prot.bind. (%) : 55 (total : 1.500 mg)
Route of elim. : kidney (unchanged) Duration of treatment :
Metabolite activity : less active 3 days

ADVERSE EFFECTS:
pruritis, GI upset, headache, fatigue, visual disturbances, dyskinesia,
neurovascular disease

LIMITATIONS : RESISTANCE.
22
MEFLOQUINE
MECHANISM OF ACTION : same as chloroquine, sensitive to : Plasmodium
falciparum and P. vivax. Class : blood schizontocide;
onset : 6 hours.

PHARMACOKINETICS PROFILE : ROUTE OF ADMINSTR.:
F (%) : 85 Oral.
t (h) : 530
Vd (L) : 1330 DOSAGE : Initial : 750 mg.
CL (L/h) : 2.0 6-8 (h) later : 500 mg
Prot. Bind. (%): 98 and 250 mg after a
Route of elim. : faecal & renal further 6-8 6-8 hr.
unchanged and DURATION OF TREATMENT:
carboxylic acid 1 (one) day.
metabolite (inactive).

ADVERSE EFFECTS:
dizziness, GI upset, headache, pruritis, skin rashes, CNS toxicity.

LIMITATIONS.
expensive, resistance (now some area was established).

23
PRIMAQUINE
MECHANISM OF ACTION : interferes with plasmodial mitochondria function,
binds to DNA. Effectve : exoerythrocytic forms of P.vivax and
P.ovale. Gametocides all forms of plasmodia.
Class : tissue schizonticides / gametocide. Onset : 1 2 hours.

PHARMACOKINETIC PROFILE: ROUTE OF ADMINISTR.
F (%) : 90 100 Oral.
t : 4 5
Vd (L) : 322 DOSAGES: 15 mg daily
CL (L/h) : 56 for duration of 14 days.
Prot. Binding (%) : --
Route of elim. : renal and faecal
Metabolite less active.

ADVERSE EFFECTS : mild anaemia, methaemoglobinaemia, depression,
confusion, cardiac arrhythmia, granulocytopenia, agranulocytosis.

24
OTHERS ANTIMALARIA.

1. Amodiaquine
2. Quinine
3. Sulfadoxine pyrimethamine (Fansidar)
4. Atovaquone proquanil (Malarone)
5. Halofantrine

6. The Artemisinin drugs :
artesunate
artemether
artemisinin
7. Artemether & lumefantrine (Co-artem)

25
26
6.The Artemisinin drugs :
artesunate : water-soluble; p.oral-iv-im-rectal.
artemether : lipid-soluble; p.oral-im-rectal.
dihydroartemisinin : water-soluble; p.oral.
QINGHAOSU China herbal medicine used as
antipyretic (over 2.000 years)
sesquiterpene lactone endoperoxidaside
active component : ARTEMISININ

PK (Pharmacokinetik) : absorbed rapid
peak conc. : 1-2 hrs
t1/2 : 1-3 hrs (p.oral)
PD (Pharmacodynamic) : schizonticides
no effect on hepatic stages

27
REGIMEN: Notes :

Artemether-lumafentrine Coformulated; first-line therapy
( Coartem, Riarnet) in many African countries.

Artesunate-amodiaquine Coformulated; first-line therapy
(ASAQ, Arsucam) in many African countries.

Artesunate-mefloquine Standart therapy in parts of
Southeast Asia.

Artesunate-sulfadoxine- First-line therapy in some
pyrimethamine countries; efficacy low compared
with others regimens in some area.

Amodiaquine-sulfadoxine- Less-expensive; recommended
Pyrimethamine as an interim option when
efficacy established and other
regimens are not available.
WHO recommendations FALCIPARUM MALARIA
28
7. Halofantrine & lumefantrine
(Co-artem)
Halofantrine :
effective ERYTHROCYTIC stages
( 4 plasmodiums)
peak plasma level : 16 hrs after dosing
half-life (t1/2) : 4 days.
excretion : GIT (feces)
AE : - alter the cardiac conduction
QT & PR interval must be controlled.
- GIT; skin rash/pruritus.
CONTRAINDICATED : pregnancy
29
Lumefantrine
Lumefantrine :
derivate halofantrine
available in fixed dose combinatioan
with ARTEMETHER (Coartem).
indication : uncomplicated falciparum
(in Africa)
t1/2 (in combination): 4,5 hrs.
oral dose : bid for 3 days.
AE : prolonged QT interval; GIT disturb,;
headache; dizziness; skin rash-
pruritis.
CHEMOPROPHYLAXIS

FOR THIS PURPOSE DRUGS ACT IN TWO WAYS :

AS SCHIZONTICIDES, when parasites enter the red cell
they are destroyed;

AS CAUSAL PROPHYLACTICS, which prevent the development
of the PE schizont in the liver, and may have schizonticidal effects.

Currently, chemoprophylaxis is routinely advise only for :
NON-IMMUNE travellers visiting endemic area
30
CHEMOPROPHYLAXIS :

1. PROGUANIL ( PALUDRINE, CHLORGUANIDE )
2. CHLOROQUINE
3. MEFLOQUINE
4. DOXYCYCLIN
5. ATOVAQUONE-PROGUANIL
6. SULFADOXINE-PYRIMETHAMINE
31
CHEMOPROPHYLAXIS /
SUPPRESSIVE DOSAGES
FOR ADULTS.
CHLOROQUINE
300 mg (base) /
week.
PYRIMETHAMINE
25 mg/week in
combination with
sulfadoxine
SULFADOXINE
500 mg/week in
combination with
pyrimetamine
MEFLOQUINE
250 mg/week
for 4 weeks, then
125 mg/week
PRIMAQUINE
45 mg(base)/week
for 8 weeks
32
33
DRUG USE DOSAGE (adult)

Chloroquine Areas without 500 mg weekly
cholorquine-resisitant
P. falciparum

Malarone Areas with chloroquine- 1 tablt daily
resistant P falciparum (250 mg atovaquone/
100 mg proquanil)

Mefloquine Areas with chloroquine- 250 mg weekly
resistant P. falciparum

Doxycycline Areas with multidrug- 100 mg dailay
resistant P. falciparum

Primaquine Terminal prophylaxis of 52,6 mg (30 mg base)
P.vivax; ovale infections; daily (14 days; after
travel)
DRUGS for PREVENTION OF MALARIA
in TRAVELERS
WHATS
THE MAIN PROBLEM
PHARMACOTHERAPY MANAGEMENT
in MALARIA ???
34
2. FILARIASIS

CAUSES : - Wuchereria bancrofti Culex
- Brugia malayi transmitted Aedes
- Brugia timori Anopheles
incubation periode :
8 16 mo.

Cause : high degree of disability
- hydrocele
- scrotal lymphedema
- lymphatic varices
- elephantiasis : extrimities, genitals, breasts

R - diethylcarbamasine
- ivermectin only as a microfilaricide combine with
diethyl carbamasine
- albendazole only as a microfilaricide
35
Diethylcarbamazine citrate (DEC)
Effective : microfilaricidal, with
dose 1-2 mg/kg BW 3 x daily for 2-3 weeks.
Adult worms require longer course of therapy and/or
multiple therapy.
Adverse effects : allergic reactions, headache, vertigo,
dizziness, malaise, fever, or myalgia.
PREVENTION :
- reduce / eradicate population of mosquito
- protect from mosquito bites
36
3. ONCHOCERCIASIS

CAUSE : O. VOLVULUS endemic area : Africa & Latin America
cause of BLINDNESS, Dermatitis, Lymphadenitis

Transmitter: female black flies ( simulium species )
R - diethylcarbamazine no effect in adult worm
- ivermectin suitable for mass treatment
dose : 400g/kg single dose, often combined
with a single dose albendazole 400 mg.
repeated at 3-month for 2-3 years.
- albendazole 400 mg 2x daily for 3 weeks
( have macrofilaricidal effects )
37
4. SCHISTOSOMIASIS

CAUSED : Trematodes (blood flukes)
S. mansoni (Africa; Arabian peninsula; South America;
the Carabbean.
S.haematobium ( Middle East and Africa )
S.mekongi (Southeast Asia)
S.intercalatum (West and Central Africa)
S. japonicum (Japan; China; Philippines)
3 stages : cercariae mature flukes eggs
R praziquantel ONLY IF LIVE OVA ARE IDENTIFIED.
oxamniquine effective only S. mansoni
metrifonate -> S. hematobium

PERMASALAHAN : ketersediaan Obat cukup sulit,tersedia
pada daerah ttt (Program: Indonesia hanya
di Sulawesi Tengah)

38
39
CLINICAL (3 major disease syndromes):
mature flukes : - dermatitis (swimmersitch)
- fever & constituional complaints
(Katayama fever)
- chronic fibro-obstructive disaese

DERMATITIS : 1-3 days after penetration of cercariae
-priritis
-papular rash
(rarely occur in primary exposure)
KATAYAMA FEVER : 4 8 weeks after penetration of the human skin
- severe in S japonicum; some times in
S mansoni;
- rare in S haematobicum
CHRONIC FIBRO-OBSTRUCTIVE:
- damage by deposition of eggs ->
chronic granulomatoous disease and fibrosis.

40
LABORATORY : - eosinophilia, hematurie, anemia
- chronic end-stage :
abnormal liver function
elevated serum creatinine
uremia
- characteristic by : schistomia eggs
(feces/urine or rectal biopsi)

DIFF.DIAG : hepatic Sch -> hepatoslenomegaly & portal
hypertension DD: alkoholic cirrh;
Wilsons disease; hepatitis C.
S haematobium -> DD ca bladder / ureteral;
CRF sometimes -> hematuria


5. LEISHMANIASIS

Syndromes :

- Visceral leishmaniasis (kala azar): L.donavani; L. infantum;
L. chagasi

- Cutaneus leishmaniasis : Old world : L. tropica; L. major;
L. aethiopica.
New world : L. mexicana.

- Mucocutaneus leishmaniasis (espundia) : Leishmania (viannia)
braziliensis; rare L(v) panamensis.

- Diffuse cutaneus leihmaniasis : L. mexicana; L. aethiopica

41
VISCERAL LEISHMANIASIS (KALA-AZAR)

ENDEMIC : -in the South-west Asia; the Indian subcontinent; China;
the Mediterranean area; east Africa; and Central and
South America

Clinic : -Chronic irregular fever, malaise, anorexia, cough, diarrhea
and secondary infections later : progressive enlargement
of the spleen and liver; lymph-nodes with anemia and
emaciation
-Untreated fatal
-After cure (in Indian subcontinent) chronic granulomatous
infiltration of the skin and patchy hypopigmentation
without ulceration

42
CUTANEOUS LEISHMANIASIS.

The Old World : in the Mediterranean area; western Asia;
the Indian subcontinent (west area) and east and west Africa.

The New World : in Central and South America ( except Chile
and Uruguay )

Characterized : a cell-mediated reaction at the site of inoculation;
immunity develops and healing occurs by fibrosis and leaving
a prominent scar.

The New World more severe and slower to heal than The Old World
43
MUCOCUTANEOUS LEISHMANIASIS.

ENDEMIC : South and Central America; Ethiopia and Kenya caused by
L.aethiopica.

Primary lesions : regional lymphangitis and lymphadenitis.

Characterized : progressive ulceration and erosion of the soft tissues
of the mucosa of the nose, mouth and pharynx espundia
This condition : appear soon after initial infection or
many year after apparent resolution of the primary lesions.
44
DIFFUSE CUTANEOUS LEISHMANIASIS

ENDEMIC : Brazil; the Dominic Republic; Mexico; and Venezuela;
and Ethiopia and Kenya ( L.aethiopica )

Primary lesion : progressive, widespread, thickening and
leprosy-like lesion.
( once established do not regress with treatment )
45
PHARMACOTHERAPEUTIC (1)

MEGLUMINE ANTIMONATE : inject. 85 mg/ml
SODIUM STIBOGLUCONATE : inject. 100 mg/ml
both contain antimony (Sb pentavalent) in 5 ml ampoule.

Dosage & adminstration : 20 mg Sb pentavalent / kg BW i.m.
duration of treatment :
- Visceral L., minimum 20 days
- Cutaneous L., local (intralesion) 1 3 ml interval 1-2 days
systemic : 10 -20 mg until clinical cure
at least 4 weeks
- Mucocutaneous L., 20 mg / kg BW i.m. until split skin
smears negative, at least 4 weeks.
In relapse should be retreated at least twice
as long.
- Diffuse cutaneous L., 20 mg / kg BW i.m. several month
until clinical improvement occurs.

46
PHARMACOTHERAPEUTIC (2)

CONTRAINDICATIONS : - severe renal disorders
- severe heart disorders
- severe liver disorders

PREGNANCY : no evidence.

ADVERSE EVENTS : dose-dependent and reversible in
ECG changes, T-wave inversion & prolongation
Q-T interval precede serious dysrhythmia.
Hepatic and renal dysfunction impairment.
Headache, malaise, dyspnoea, skin rashes,
Abdominal pain and facial oedema.

47
PHARMACOTHERAPEUTIC (3)

Others :
Pentamidine : all type of Leishmaniasis
dosage : 3 4 mg / kg BW by deep i.m.or slow iv (>60)
for duration : 5 to 25 weeks.
CI : renal impairment
hypersensitive
AE: - mild nephrotoxicity
- acute hypotension and syncope ( rapid iv )
- hypoglycaemia ( pancreatic damage ),
- hypocalcemia; GI effects; confusion, hallucinations;
cardiac dysrhythmias; local induration ( sterile
abscess);
- rare : thrombocytopenia; leucopenia;
Stevens-Johnson syndrome; abnormal hepatic functions.

Amphotericin B also as anti fungal.




48
6. TRYPANOSOMIASIS.

AFRICAN ( sleeping sickness )
7. AMERICAN ( Chagas diseases )

AFRICAN TRYPANOSOMIASIS.
Pharmacotherapeutics :
1. PENTAMIDINE. Injection 200, 300 mg each vial.
2. SURAMINE. Injection 1 g / vial.
3. MELARSOPROL. Injection 36 mg / vial.
4. EFLORNITHINE. Injection 200 mg in 100 ml ampoule.

AMERICAN TRYPANOSOMIASIS.
Pharmacotherapeutics :
1. BENZNIDAZOLE. Tablet 100 mg
2. NIFURTIMOX. Tablet 30, 120 and 250 mg.
49
50
8. AMOEBIASIS
Caused : ENTAMOEBA HISTOLYTICA (an protozoan)
common tropical diseases
spread : fecal
primary affect : colon;
seconadary : liver, lungs and brain
CLASSIFICATION : 1. INTESTINAL & EXTRAINTESTINAL
AMOEBIASIS
2. INTESTINAL AMOEBIASIS
3. EXTRAINTESTINAL AMOEBIASIS
51
INTESTINAL & EXTRAINTESTINAL
AMOEBIASIS :
metronidazole; tinidazole; secnidazole;
ornidazole; satranidazole; emetine;
dehydroemetine.

INTESTINAL AMOEBIASIS:
diloxanide furoate; quinodochlor;
iodoquinol; tetracyclin; paromomycin.

EXTRAINTESTINAL AMOEBIASIS :
chloroquine
REFERENCES.

1. Gill, G.V., Beeching, N.J.; (2004) Lecture Notes TROPICAL MEDICINE, 5
th
Ed.,
Blackwell Publishing.

2. WHO; ( 1995 ) , Drugs Used in Parasitic Diseases, 2
nd
Ed., WHO-Geneva.

3. Eddlestone, M., et al., ( 2005 ) Oxford Handbook of TROPICAL MEDICINE;
2
nd
Ed., Oxford University Press.

4. Neal, M J., ( 2005 ) Medical Pharmacology at a Glance, 5
th
Ed, Blackwell
Publishing.

5. Udaykumar, P., (2011) Medical Pharmacology, 3
rd
Ed., CBS Publisher,
New Delhi.

6. Katzung, B G., ( 2012 ) Basic and Clinical Pharmacology, 12
th
Ed., McGraw Hill.


52