CHEMOTHERAPY OF PARASITIC DISEASESANTI PROTOZOAL DRUGSCHEMOTHERAPYOF AMOEBIASIS* CHLOROQUINE* DILOXANIDE FUROATE* DEHYDROEMETINE* EMETINE* METRONIDAZOLE* DERIVATES OF 8 - HYDROXYQUINOLINESCHEMOTHERAPYOF MALARIA* PRIMAQUINE* CHLOROQUINE* QUININE* MEFLOQUINE* PYRIMETHAMINE* CHLOROGUANIDE

CHEMOTHERAPY OF PARASITIC DISEASESCHEMOTHERAPY OF HELMINTHIASISCHEMOTHERAPYOF NEMATODES* Mebendazole* Pyrantel pamoate* Thiabendazole* DECCHEMOTHERAPYOF TREMATODES* PraziquantelCHEMOTHERAPYOF CESTODES* Niclosamide

CHEMOTHERAPY OF AMOEBIASISAMOEBIASIS :CAUSED BY : Entamoeba histolyticaLocation : * Intestine ( Colon ) * Liver and otherCLASSIFICATION OF AMEBICIDES1. LUMINAL AMEBICIDES :Diloxanid furoate, tetracycline, paromomycin, iodoquinol

2. SYSTEMIC AMEBICIDES :Emetin, dehydroemetin, chloroquine

3. MIXED AMEBICIDES :metronidazol

I. LUMINAL AMEBICIDES : 1. Diloxanide furoate about 90 % absorbed. The unabsorbed drug is an active drug Intestinal amebiasis only Side effects: flatulence, dryness of the mouth, pruritus urticaria Contraindicated : pregnant women, children under 2 years of age

3. Paromomycin * an aminoglycoside antibiotic * direct amebicid * adverse effects : gastrointestinal distress, diarrhea2. 8-hydroxyquinolines * Preparation : iodoquinol Clioquinol ( iodochlor hydroxyquin ) * Significant risk of the clioquinol, 2 gr/day for long periods is SMON (subacute myelo-optic- neuropathy) * Not for routine use

II. SYSTEMIC AMEBICIDE

1. Chloroquine * used in conjunction with metronidazole and diloxanid furoate * eliminates trophozoites in liver abscesses

2. Emetine, dehydroemetine * Their use is limited by their toxicities * Un toward effects :- pain in site of injection- transient nausea- cardiotoxicity- neuromusscular weakness- dizzness- rashes

III. MIXED AMOEBICIDES Metronidazole * Combination metronidazole plus a luminal amebicide/difuloxanid furoate cure rates >90 %

* For treating infections caused by : E.histolytica G.lamblia Trichomonas vaginalis

* For treating infections caused by : anaerobic cocci anaerobic gram-negative bacilli (Bacteriades spp) anaerobic gram-positive bacilli (Clostridia)

* Effective in the treatment of brain abscess (caused by E.histolytica)

Resistance :Strains of trichomonas resistent to metronidzol has been reported

Administration and DistributionOral administration, completely and rapidly absorbedUsually administered with a luminal amebicide (DF)It distributes well through out body tissue and fluidsThe drug can be found in therapeutic level in vaginal and seminal fluids, saliva, CSF

Metabolim: metabolism in the liver by mixed function oxidase follow by glucuronidation Phenobarbital enhance the rate metabolismCimetidine decrease the rate metabolism

Adverse Effect :Gastrointestinal effect : nausea, vomiting,epigastric distress, abdominal cramps Neurotoxicological problems Reversible neutropenia Not recommended during the first trimester of pregnancy

Therapeutic Uses:

In the treatment of infectious with T.vaginalis:Genital infectious :female and maleDo: 2 g single dose or 250 mg 3 times daily for 7 daysUncured or reccurent interval of 4 to 6 week between coursesUnsatisfactory response:Chronic infection of Skenes and Bartholins glandsReinfection by partner 2 g to both sexual partner and given gel or vag supp.

In the treatment of AmebiasisDOC of all symptomatic forms of amebiasisDosage: 750 mg, 3 times daily ,5 - 10 daysLeast effective to an asymptomatic passer of cyst in combination with diloxanideExtremely useful for treatment of seriousanaerobic bacteria infection:Bacteriodes, Clostridium, Fusobacterium, Peptococcus, Peptostreptococcus, Eubacterium and Helicobacter.