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Chapter 25 : Treatment of Parasitic Infections
Chemotherapy plays a very important role not only in reducing patient morbidity and mortality but also in reducing transmission of the parasitic infection. Many of the drugs used to treat parasitic infections have serious side effects; therefore, before initiation of therapy, it is important to consider the following factors: health of the patient, parasite drug resistance, accuracy of the original dose, potential drug toxicity, and the need for follow-up examinations to monitor therapy. This chapter talks about antiparasitic drugs that include albendazole, amphotericin B, amphotericin B, artemether and benznidazole. The systemic anthelmintic activity has been attributed to the primary metabolite, albendazole sulfoxide. Patients being treated for neurocysticercosis should receive appropriate steroid and anticonvulsant therapy as required. Oral or intravenous corticosteroids should be considered to prevent cerebral hypertensive episodes during the first week of anticysticercal therapy. AmBisome treatment resulted in a lower incidence of chills, hypertension, hypotension, tachycardia, hypoxia, hypokalemia, and various events related to decreased kidney function compared with amphotericin B deoxycholate. Corticosteroids and adrenocorticotropic hormone may lead to hypokalemia. The drug may increase the bone marrow toxicity of ganciclovir. Probenecid may increase the levels of amphotericin B. The artemisinin-based combinations artemether- lumefantrine and artesunatemefloquine remain highly effective and elicit equivalent therapeutic responses in the treatment of highly drugresistant falciparum malaria. Benznidazole inhibits protein and RNA synthesis in Trypanosoma cruzi; it causes increased phagocytosis, cytokine release, and production of reactive mitogen intermediates that lead to death of the parasites.