510 Week 7 antifungal second half
Terbinafine treats tinea capitis, tinea pedis, tinea corporis, tinea cruris, and tinea versicolor.
Terbinafine is the first-line oral agent for mild to moderate onychomycosis.
Itraconazole is an alternative systemic treatment for patients who cannot tolerate terbinafine or fail to respond to terbinafine.
Contraindications for Terbinafine are Hepatic disease, and sun/UV.
Terbinafine is for long term dosing (several weeks).
Griseofulvin treats Tinea capitis and is Very popular in the pediatric population.
Griseofulvin is used for onychomycosis
Griseofulvin causes disulfiram like reaction if taken with alcohol (face flushing, N/V).
Griseofulvin should be taken with a fatty meal.
Echinocandins have potent activity against Aspergillus and most Candida species.
Echinocandins include caspofungin, micafungin, and andidulafungin.
Echinocandins are available by IV once daily.
Amebiasis is an infection of the intestinal track caused by E. histolytica.
Amebiasis is transmitted by ingestion of cysts from fecally contaminated food and/or water.
Complication of Amebiasis is liver abscess
Metronidazole is the first line treatment for symptomatic Amebiasis.
Tinidazole is the second line treatment for symptomatic Amebiasis.
Paromomycin is intraluminal antiparasitic that treats asymptomatic disease and is usually added to Metronidazole or Tinidazole depending on severity.
Iodoquinol is an option to add on if needed with Metronidazole or Tinidazole to treat Amebiasis.
Chloroquine is added on to treat Amebiasis if there is liver abscess.
Metronidazole can be taken topical and po.
Metronidazole is a Nitroimidazole that treats bacterial and parasitic infections
Metronidazole treats Amebiasis, Giardia, Trichomonas, C. Diff, and H. pylori.
Metronidazole can cause a Disulfiram like reaction if taken with alcohol.
Metronidazole can be used during pregnancy if necessary but try to avoid in first trimester (known to cause cleft palate).
Iodoquinol can cause peripheral neuropathy and rare optic neuritis.
Paromomycin is used treatment of asymptomatic amebiasis and better for pregnant patients compared to metronidazole.
Chloroquine is an antimalarial/ amebicide agent.
Chloroquine is the treatment and prophylaxis of uncomplicated malaria.
Chloroquine treats Extraintestinal amebiasis (cysts in the liver ).
Chloroquine causes blurred vision/irreversible retinopathy.
Chloroquine is the drug of choice for prophylaxis and treatment of sensitive malaria species during pregnancy
Malaria is red blood cell disease caused by Plasmodium.
Plasmodium falciparum and P. knowlesi infections can cause rapidly progressive severe illness or death.
Plasmodium vivax, Plasmodium ovale and Plasmodium malariae are less likely to cause severe disease.
Plasmodium vivax and Plasmodium ovale infections also require treatment for the hypnozoites, which remain dormant in the liver and can cause relapsing episodes.
Chloroquine or hydroxychloroquine can treat Plasmodium falciparum infections acquired in areas without chloroquine-resistant strains, which include Central America west of the Panama Canal, Haiti, and the Dominican Republic. Patients can be treated with oral chloroquine, or, alternatively, hydroxychloroquine at recommended doses.
Chloroquine can treat Plasmodium malariae and Plasmodium knowlesi.
For P. falciparum infections acquired in areas with chloroquine resistance, four treatment options are available. (in order of recommendation)
1. Artemisinin combination therapy (ACT) regimens.
2. Atovaquone-proguanil
3. Quinine sulfate plus doxycycline, tetracycline, or clindamycin(last resort) is also a treatment option.
4. Mefloquine
Atovaquone-proguanil
Atovaquone-proguanil should not be as malaria prophylaxis during pregnancy.
What about the others?
Quinine must be administered with another medication to be effective in treating malaria.
Major adverse effect of Quinine is cinchonism
Cinchonism is a syndrome that involves nausea, vomiting, tinnitus, and vertigo. Cinchonism can cause hemolytic anemia.
Mefloquine can be used as prophylaxis and treatment of malaria. Mefloquine is associated with retinopathy and neurological issues. Mefloquine causes Neuropsychiatric Adverse Events.
Primaquine treats malaria (P. vivax or P. ovale) but not used alone.
Primaquine causes Drug induced hemolytic anemia in patients with G6PD
Prophylaxis Recap- Malaria
Chloroquine can be used as a prophylaxis for malaria for pregnant patients.
Mefloquine can be used as a prophylaxis for malaria for pregnant patients.
Atovaquone-proguanil is used as a prophylaxis for malaria (but not for pregnant ones).
Doxycycline is used as a prophylaxis for malaria but not for pregnant patients.
Benznidazole treats Chagas disease (American trypanosomiasis).
Trypanosoma cruzi causes Chagas disease.
Benznidazole treats disease caused by Trypanosoma cruzi .
Sleeping sickness ( African trypanosomiasis) can cause neurological problems.
Pentamidine treats early Trypanosoma brucei gambiense (no neurological problems). Eflornithine treats late Trypanosoma brucei gambiense (neurological problems)
Suramin treats early Trypanosoma brucei rhodesiense (no neurological problems).
Melarsoprol treats late Trypanosoma brucei rhodesiense (neurological problems).
Benznidazole treats Chagas.
Pentamidine is an anti-infective (fungal/protozoal) agent.
Pentamidine treats Trypanosomiasis ( T. brucei gambiense) in the early stage (meaning it has not crossed CNS).
Pentamidine is used as a Prophylaxis and treatment of Pneumocystis pneumonia (second line agent).
Pentamidine treats Leishmaniasis.
Pentamidine does not enter CSF and will be useless against late stages of CNS involvement
Pentamidine causes acute kidney injury, Pancreatitis, and Hypo/hyperglycemia (pancreatic islet damage).
Leishmaniasis is very rare.
Leishmaniasis is transmitted to humans through the bite of infected sandflies.
Leishmaniasis can manifest as a Cutaneous, Mucocutaneous, or Visceral ( parasite is in the blood stream) infection.
Sodium stibogluconate, Miltefosine, Pentamidine all treat Leishmaniasis.
Treat patients with acute toxoplasmosis with Pyrimethamine plus sulfadiazine or Pyrimethamine plus clindamycin plus leucovorin calcium.
Pyrimethamine causes megaloblastic anemia secondary to folate deficiency so it should not be prescribed alone.
When prescribing Pyrimethamine plus sulfadiazine, also prescribe Leucovorin to prevent hematologic complications due to pyrimethamine-induced folic acid deficiency state.
Pinworms are Enterobius vermicularis
Roundworms are Ascaris lumbricoides or Trichinosis or strongyloidiasis
Hookworms are Necator americanus or Ancylostoma duodenale
Tapeworms are Taenia
Flukes are Schistosoma –
Schistosoma is a worm you find in fresh water.
Schistosoma penetrates skin and goes to organs, causing portal hypertension.
Enterobiasis Vermicularis aka pinworm is the most common helminthic infection in the US.
Common Enterobiasis Vermicularis patient is a child who comes in with itchy butt, especially at night.
Treatment options for Enterobiasis Vermicularis: Mebendazole, Albendazole, and Pyrantel.
Mebendazole is usually the best option to treat Enterobiasis Vermicularis.
Medications to treat Enterobiasis Vermicularis (aka Pinworm) have to be repeated in 2 weeks.
Trichinosis (Roundworm) is caused by Trichinella species due to eating raw or undercooked meat like pork, wild boar, or bear.
Mebendazole and Albendazole both treat Trichinosis (Roundworm).
Ancylostoma duodenale or Necator - Hookworm
Ancylostoma duodenale or Necator (Hookworm) is common in areas with poor access to water, sanitation, and hygiene.
Hookworm has sharp teeth and will make pt bleed and have iron deficiency.
Mebendazole, Albendazole, and Pyrantel all treat Ancylostoma duodenale or Necator (hookworm).
Albendazole is the preferred treatment for Ancylostoma duodenale or Necator (Hookworm).
Ascariasis (Roundworm) is the most common intestinal helminth worldwide
Mebendazole, Albendazole, Pyrantel and Ivermectin all treat Ascariasis (Roundworm).
Albendazole is a anthelminthic/parasitic medication.
Albendazole treats Parasitic worm infections
Albendazole is contraindicated in pregnancy 1st trimester.
Mebendazole is an anthelminthic/parasitic medication.
Mebendazole treats Pinworms, Whipworm, Roundworm, Hookworm infections
Mebendazole is contraindicated in 1st trimester pregnancy.
Pyrantel pamoate is an anthelminthic/parasitic medication
Pyrantel pamoate is contraindicated in 1st trimester pregnancy.
Ivermectin treats roundworms like Ascariasis, strongyloidiasis, and onchocerciasis ( roundworm that causes blindness).
Ivermectin can cause Mazzotti reaction ( fever, headache, dizziness, somnolence, and hypotension) by killing the parasite causes this reaction. Antihistamines or steroids can help this.
Somnolence is excessive sleepiness or drowsiness and is part of the Mazzotti reaction.
Praziquantel has activity against schistosomiasis (flatworms), intestinal tapeworms ( i.e. beef tapeworm Taenia saginata or pork tapeworm Taenia solium).