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Amebiasis

Classification of antiamebic drugs


1. Tissue Amebicides
(a) For both intestinal and extraintestinal
amoebiasis:
Nitroimidazoles: Metronidazole, Tinidazole,
Secnidazole, Ornidazole, Satranidazole
Alkaloids: Emetine, Dehydroemetine
(b) For extraintestinal amoebiasis only:
Chloroquine
2. Luminal amoebicides
(a) Amide : Diloxanide furoate, Nitazoxanide
(b) 8-Hydroxyquinolines: Quiniodochlor
(Iodochlorohydroxyquin, Clioquinol),
Diiodohydroxyquin (Iodoquinol)
(c) Antibiotics: Tetracyclines, Paromomycin

Paromomycin is an alternative drug


for giardiasis, especially during 1st
trimester of pregnancy when
metronidazole and other drugs are
contraindicated.
It has been used in cryptosporidiosis,
but efficacy is uncertain.
Topically, it may used in trichomonas
vaginitis and dermal leishmaniasis.
amoebiasis/giardiasis/cryptosporidiosis.
Side effects are limited to the g.i.t.;
nausea, vomiting, abdominal cramps,
diarrhoea; rarely rashes.

Paromomycin is an efficacious luminal


amoebicide, achieving similar or even
better clearing of cysts from stools
compared to diloxanide furoate in
asymptomatic cyst passers.
Good symptomatic relief and cyst
clearance is obtained in chronic amoebic
colitis. It can be given along with
metronidazole in acute amoebic dysentery
as well as in hepatic amoebiasis to
eradicate the luminal cycle.
In India and Africa, parenteral (i.m.)
paromomycin is being used in resistant
Kalaazar

Asymptomatic cyst passers are mostly


treated with only luminal amoebicide.
Chronic cases may require 23 repeated
courses in which drugs may be alternated.
A tetracycline may be given
concurrently with the luminal
amoebicide in cases which fail to clear
completely.
inhibit the bacterial flora with which
Entamoebae live symbiotically. Thus, they
indirectly reduce proliferation of
entamoebae in the colon and are especially
valuable in chronic, difficult to treat
cases

Nitroimidazoles
Metronidazole
- Anaerobic in A,G, TV
Anarobes B Fragilis,
Fusobacterium,Clostridium
perfringens, Cl. difficile,
Helicobacterpylori, Campylobacter,
peptococci, Dracunculus medinensis,
extraction of the worm from under
the skin is facilitated

selectively toxic to anaerobic and


microaerophilic microorganisms
- enters the cell by diffusion
- its nitro group is reduced to a highly
reactive nitro radical which exerts
cytotoxicity
- inhibit cell mediated immunity, to
induce mutagenesis and to cause
radiosensitization

- attaining therapeutic concentration in


vaginal secretion, semen, saliva and CSF.
Plasma t is 8 hrs.
Anorexia, nausea, metallic taste and
abdominal cramps, Loose stools
glossitis, dryness of mouth
Head ache, dizziness
Urticaria, flushing, heat, itching, rashes and
fixed drug eruption occur in allergic subjects,

Peripheral neuropathy and CNS


effects. Seizures have followed very
high doses. Leucopenia is likely with
repeated courses.
Thrombophlebitis
Contraindicated in neurological
disease, blood dyscrasias, first
trimester of pregnancy
Cautious use in chronic alcoholics. A
disulfiram-like intolerance

Preferred over vancomycin which


may be used in nonresponsive cases,
or when the infection recurs;
Pseudomembranous enterocolitis
due to Cl. difficile

Tinidazole
t is ~12 hr; duration, suited for single
dose or once daily therapy. higher cure
rates. better tolerated
Secnidazole; t of 1729 hours
Ornidazole; t (1214 hr).
Satranidazole; t (14 hr).
- tolerability:no nausea, vomiting or
metallic taste, absence of neurological
and disulfiramlike reactions

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