Treatments in Sarcomastigophora

Luminal amebicides, Tissue amebicides, Both luminal and tissue amebicides

Three classes of drug are used in the treatment of amebiasis:

Diloxanide furoate, iodoquinol, paromomycin and tetracycline act in the intestinal lumen but not in tissues.

Entamoeba histolytica

Luminal amebicides

Emetine, chloroquine, etc. are effective in systemic infection, but less effective in the intestine. Dosage of chloroquine in amebic liver abscess is l gram for 2 days followed by 5 grams daily for 3 weeks

Entamoeba histolytica

Tissue amebicides

Metronidazole and related compounds like tinidazole and ornidazole act on both sites and are the drug of choice for treating amebic colitis and amebic liver abscess.

Entamoeba histolytica

Both luminal and tissue amebicides

2 g/day orally for 3 days

Entamoeba histolytica

Dosage of tinidazole

750 mg three times a day, orally or intravenously for 5-10 days

Entamoeba histolytica

Dosage of metronidazole

30 mg/kg four times a day, orally in three divided doses for 5-10 days

Entamoeba histolytica

Dosage of paramomycin

60 mg orally, three times a day for 20 days

Entamoeba histolytica

Dosage of iodoquinol

topical administration of biguanide or chlorhexidine with or without diamidine agent. In severe cases, where vision is threatened, penetrating keratoplasty can be done

In acanthamoeba keratitis, current therapy involves topical administration of —. In severe cases, where vision is threatened, penetrating — can be done

pentamidine, sulfadiazine, rifampicin and fluconazole are being used

No effective treatment is available for GAE. Multidrug combinations including —are being used with limited success.

250mg, thrice daily for 5-7 days ; 2g single dose

Giardia lamblia

Metronidazole (—) and tinidazole (—) are the drugs of choice.

90%

Giardia lamblia

Cure rates of metronidazole

Timidazole

Giardia lamblia

Which is more effective, metronidazole or tinidazole

100 mg QID(4x a day) x 7 days ; 500 mg BD(twice a day) x 3 days

Giardia lamblia

Furazolidone (—) and nitazoxanide (—) are preferred in children, as they have fewer adverse effects.

500 mg TDS three times a day x 5 days

Giardia lamblia

Paromomycin, an oral aminoglycoside, can be given to symptomatic pregnant females (—).

2g orally as a single dose or 500 mg orally twice a day for 7 days

Trichomonas vaginalis

Simultaneous treatment of both partners is recommended as it is an STD.

Metronidazole —is the drug of choice.

the dose of metronidazole may be increased or it may be administered parenterally.

Trichomonas vaginalis

Simultaneous treatment of both partners is recommended as it is an STD.

In patients not responding to treatment with standard regime, —

metronidazole is safe in 2nd and 3rd trimesters

Trichomonas vaginalis

Simultaneous treatment of both partners is recommended as it is an STD.

In pregnancy, ??

Pentamidine - 3 - 4 mg/kg of body weight, intramuscularly daily for 7- 10 days.

Trypanosoma brucei

Stage I

Pentamidine - the drug of choice for gambiense Human African trypanosomiasis (HAT).

Dose: —

Suramin 20 mg/kg of body weight in a course of five injections intravenously, at an interval of 5- 7 days.

Trypanosoma brucei

Stage I

Suramin - the drug of choice for rhodesiense Human African trypanosomiasis (HAT).

Dose: —

Suramin does not cross blood-brain barrier but it is nephrotoxic.

2-3 mg/kg/ per day (maximum 40 mg) for 3-4 days

Trypanosoma brucei

Stage II

Melarsoprol (Mel-B) - is the drug of choice, as it can cross the blood- brain barrier.

Dose: —

Nifurtimox: 8-10 mg/kg for adults and 15 mg/kg for children. The drug should be given orally in four divided doses each day for 90- 120 days.

Trypanosoma cruzi

No effective specific treatment is available for treating Chagas disease

Nifurtimox

Benzinadole 5- 10 mg/day orally for 60 days.

Trypanosoma cruzi

No effective specific treatment is available for treating Chagas disease

Benznidazole: —

pentavalent antimonial compound, which is the drug of choice in most of the endemic regions of the world, but there is resistance to antimony in Bihar in India, where amphotericin-B-deoxycholate or miltefosine is preferred.

Leishmania

Kala-azar responds to treatment better than other forms of VL. The standard treatment consists of —

Sodium stibogluconate (100 mg of Sbv/mL) (SSG) Meglumine antimoniate (85 mg of Sbv/mL).

Leishmania

Kala-azar

Pentavalent Antimonial Compound - Two pentavalent antimonial (Sbv) preparations are available:

The daily dose is 20 mg/kg by rapid intravenous (TV) infusion or intramuscular (IM) injection for 20 - 30 days.

Leishmania

Kala-azar

Dosage of Pentavalent antimonial compound

90% in most of the old world, except in Bihar (India) due to resistance (cure rate 36%).

Leishmania

Kala-azar

Cure rates exceed —

Amphotericin - B - 0.75-1.0 mg/kg on alternate days for a total of 15 infusions.

Leishmania

Kala-azar

Amphotericin-B - currently used as a first-line drug in Bihar. ln other parts of the world, it is used when initial antimonial treatment fails.

Dosage

Note: Fever with chills is almost seen in all patients, using amphotericin-B infusions.

It is given in a dose of 11 mg/kg daily for 21 days

Leishmania

Kala-azar

Paromomycin - is an intramuscular aminoglycoside antibiotic with anti- leishmanial activity.

Dosage: —

50 mg daily for 28 days for patients weighing less than 25 kg, and twice daily for patients weighing more than 25 kg.

Leishmania

Kala-azar

Miltefosine - is the first oral drug, approved for the treatment of leishmaniasis.

Dosage:—.

2.5 mg/kg/day for 20 days or sodium stibogluconate (SSG) 20 mg/ kg/day for 40- 60 days are given

Leishmania

PKDL

Liposomal amphotericin-B (AmBisome) - It has been developed and used extensively to treat VL in all parts of the world.

Dosage: —