Chapter 147 : Antiparasitic Agents

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There are a number of effective antiprotozoal and anthelmintic drugs currently available. These antiparasitic agents are important both for therapy of individual patients and for control of parasitic infections at the community level. This chapter focuses on the mechanisms of action, pharmacology, clinical utility, and adverse effects of common first-line antiparasitic therapies and newer drug alternatives. Most helminth infections in humans can be treated with one of five drugs, namely, albendazole, mebendazole, praziquantel, ivermectin, and diethylcarbamazine (DEC), so these five drugs are reviewed. A newer agent, nitazoxanide, which has both anthelmintic and antiprotozoal activity, is discussed. The chapter also reviews other major antiprotozoal drugs, including those used for malaria, gastrointestinal protozoal infection, leishmaniasis, and trypanosomiasis. The quinoline derivatives can be divided into the following four groups: the 4-aminoquinolines; the cinchona alkaloids; synthetic compounds, such as mefloquine and halofantrine; and the 8-aminoquinolines. The two agents used for treatment of American trypano-somiasis are nifurtimox and benznidazole. Nifurtimox has significant side effects that preclude the completion of therapy in many patients. Less frequent but more-severe toxicities include psychosis and convulsions. Benznidazole crosses the placenta, but there are minimal data regarding teratogenic effects of either agent in either animals or humans.

Citation: Leder K, Weller P. 2011. Antiparasitic Agents, p 2277-2295. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch147
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Treatment of major protozoal infections

Adapted from reference .

Citation: Leder K, Weller P. 2011. Antiparasitic Agents, p 2277-2295. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch147
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Treatment of major helminthic infections

Adapted from reference .

This is not an exhaustive list of all possible parasitic infections, but commonly encountered parasites are included.

No longer manufactured and/or problems with availability.

Citation: Leder K, Weller P. 2011. Antiparasitic Agents, p 2277-2295. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch147
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Major indications for albendazole

Adapted from reference .

Citation: Leder K, Weller P. 2011. Antiparasitic Agents, p 2277-2295. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch147
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Major indications for mebendazole

Adapted from reference .

Citation: Leder K, Weller P. 2011. Antiparasitic Agents, p 2277-2295. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch147
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Major indications for praziquantel

Adapted from reference .

Citation: Leder K, Weller P. 2011. Antiparasitic Agents, p 2277-2295. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch147
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Major indications for ivermectin

Adapted from reference .

Citation: Leder K, Weller P. 2011. Antiparasitic Agents, p 2277-2295. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch147
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Major indications for DEC

Adapted from reference .

Citation: Leder K, Weller P. 2011. Antiparasitic Agents, p 2277-2295. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch147
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Major indications for nitazoxanide

Adapted from reference .

The dosing schedule for nitazoxanide given as a twice-daily (b.i.d.) treatment course for 3 days consists of the following: for children 1 to 3 years of age, 100 mg b.i.d. for 3 days; for children 4 to 11 years of age, 200 mg b.i.d. for 3 days; and for adults, 500 mg b.i.d. for 3 days.

Licensed for this use by the U.S. FDA.

Citation: Leder K, Weller P. 2011. Antiparasitic Agents, p 2277-2295. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch147

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