CHEMOTHERAPY OF PARASITIC DISEASES

ANTI PROTOZOAL DRUGS

CHEMOTHERAPY CHEMOTHERAPY
OF AMOEBIASIS OF MALARIA

* CHLOROQUINE * PRIMAQUINE
* DILOXANIDE FUROATE * CHLOROQUINE
* DEHYDROEMETINE * QUININE
* EMETINE * MEFLOQUINE
* METRONIDAZOLE * PYRIMETHAMINE
* DERIVATES OF * CHLOROGUANIDE
8 - HYDROXYQUINOLINES
 CHEMOTHERAPY OF PARASITIC DISEASES

CHEMOTHERAPY OF HELMINTHIASIS

CHEMOTHERAPY CHEMOTHERAPY
OF NEMATODES OF TREMATODES

* Mebendazole * Praziquantel
* Pyrantel pamoate
* Thiabendazole
* DEC
CHEMOTHERAPY
OF CESTODES
* Niclosamide
 CHEMOTHERAPY OF AMOEBIASIS
AMOEBIASIS :
CAUSED BY : Entamoeba histolytica
Location : * Intestine ( Colon )
* Liver and other
CLASSIFICATION OF AMEBICIDES
1. LUMINAL AMEBICIDES :
Diloxanid furoate, tetracycline, paromomycin,
iodoquinol

2. SYSTEMIC AMEBICIDES :
Emetin, dehydroemetin, chloroquine

3. MIXED AMEBICIDES :
metronidazol
I. LUMINAL AMEBICIDES :

1. Diloxanide furoate
about 90 % absorbed.
The unabsorbed drug is an active drug
Intestinal amebiasis only
Side effects:
flatulence, dryness of the mouth, pruritus
urticaria
Contraindicated : pregnant women,
children under 2 years of age
2. 8-hydroxyquinolines
* Preparation : iodoquinol
Clioquinol ( iodochlor hydroxyquin )
* Significant risk of the clioquinol, 2 gr/day for long
periods is SMON (subacute myelo-optic-
neuropathy)
* Not for routine use

3. Paromomycin
* an aminoglycoside antibiotic
* direct amebicid
* adverse effects : gastrointestinal distress,
diarrhea
II. SYSTEMIC AMEBICIDE

1. Chloroquine
* used in conjunction with metronidazole and
diloxanid furoate
* eliminates trophozoites in liver abscesses

2. Emetine, dehydroemetine
* Their use is limited by their toxicities
* Un toward effects :
- pain in site of injection
- transient nausea
- cardiotoxicity
- neuromusscular weakness
- dizzness
- rashes
III. MIXED AMOEBICIDES
Metronidazole
* Combination metronidazole plus a luminal
amebicide/difuloxanid furoate cure rates >90 %

* For treating infections caused by :

E.histolytica
G.lamblia
Trichomonas vaginalis

* For treating infections caused by :

anaerobic cocci
anaerobic gram-negative bacilli (Bacteriades spp)
anaerobic gram-positive bacilli (Clostridia)

* Effective in the treatment of brain abscess

(caused by E.histolytica)
Resistance :
Strains of trichomonas resistent to metronidzol has
been reported

Administration and Distribution

Oral administration, completely and rapidly
absorbed
Usually administered with a luminal amebicide
(DF)
It distributes well through out body tissue and
fluids
The drug can be found in therapeutic level in
vaginal and seminal fluids, saliva, CSF
Metabolim:
metabolism in the liver by mixed function
oxidase follow by glucuronidation
Phenobarbital enhance the rate metabolism
Cimetidine decrease the rate metabolism

Adverse Effect :
Gastrointestinal effect : nausea,
vomiting,epigastric distress, abdominal
cramps
Neurotoxicological problems
Reversible neutropenia
Not recommended during the first trimester of
pregnancy
Therapeutic Uses:

1. In the treatment of infectious with T.vaginalis:

Genital infectious :female and male
Do: 2 g single dose or 250 mg 3 times daily
for 7 days
Uncured or reccurent interval of 4 to 6
week between courses
Unsatisfactory response:
Chronic infection of Skenes and
Bartholins glands
Reinfection by partner
2 g to both sexual partner and given
gel or vag supp.
2. In the treatment of Amebiasis
DOC of all symptomatic forms of amebiasis
Dosage: 750 mg, 3 times daily ,5 - 10 days
Least effective to an asymptomatic passer
of cyst in combination with diloxanide

3. Extremely useful for treatment of serious

anaerobic bacteria infection:
Bacteriodes, Clostridium, Fusobacterium,
Peptococcus, Peptostreptococcus, Eubacterium
and Helicobacter.