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Roomies Collab Deck 1: Infectious Disease and CV > Anti-protozoal drugs > Flashcards

Anti-protozoal drugs Flashcards

https://bnf.nice.org.uk/treatment-summary/antiprotozoal-drugs.html

1
Q

What is the first-line drug for acute invasive amoebic dysentery?

A

Metronidazole
- 800mg 3 times a day for 5 days (10 days if extra-intestinal infection) (adult)

Followed by 10-day course of diloxanide furoate

Second line: tinidazole
- 2g once daily for 2-3 days (adult)

Metronidazole: https://bnf.nice.org.uk/drug/metronidazole.html

Tinidazole:
https://bnf.nice.org.uk/drug/tinidazole.html

https://bnf.nice.org.uk/treatment-summary/antiprotozoal-drugs.html

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2
Q

For the treatment of acute invasive dysentery, following metronidazole (or tinidazole), what drug do you give for 10 days to destroy any amoebae in the GI tract?

A

Diloxanide furoate

https://bnf.nice.org.uk/treatment-summary/antiprotozoal-drugs.html

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3
Q

What is the drug of choice for asymptomatic patients with Entamoeba histolytica cysts in the faeces?

A

Diloxanide furoate

https://bnf.nice.org.uk/treatment-summary/antiprotozoal-drugs.html

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4
Q

What are the two drug options for amoebic abscesses of the liver?

A

Metronidazole
- 800mg 3 times a day for 5 days (10 days if extra-intestinal infection) (adult)

Tinidazole
- 1.5-2 g once daily for 3-6 days (adult)

https://bnf.nice.org.uk/treatment-summary/antiprotozoal-drugs.html

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5
Q

What is the first-line drug for the treatment of Trichomonas vaginalis?

A

Metronidazole
- 200 mg 3 times a day for 7 days (or 400-500 mg twice a day for 5-7 days or 2 g for 1 dose) (adult)

Second line: tinidazole
- 2g for 1 single dose

Metronidazole:
https://bnf.nice.org.uk/drug/metronidazole.html

Tinidazole:
https://bnf.nice.org.uk/drug/tinidazole.html

https://bnf.nice.org.uk/treatment-summary/antiprotozoal-drugs.html

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6
Q

What is the first-line drug for the treatment of Giardia lamblia infections?

A

Metronidazole
- 2 mg once daily for 3 days (alternative 400 mg 3 times a day for 5 days or 500 mg twice daily for 7-10 days)

Second line (2 options):
Tinidazole
- 2 g for 1 single dose
OR
Mepacrine hydrochloride
- 100 mg every 8 hours for 5-7 days

Metronidazole:
https://bnf.nice.org.uk/drug/metronidazole.html

Tinidazole:
https://bnf.nice.org.uk/drug/tinidazole.html

Mepacrine hydrochloride:
https://bnf.nice.org.uk/drug/mepacrine-hydrochloride.html

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7
Q

What is the one indication for use of the drug mepacrine hydrochloride?

A

Giardiasis
- by mouth 100 mg every 8 hours for 5-7 days

(mepacrine hydrochloride is a second-line drug for giardiasis)

First-line for Giardiasis: Metronidazole
- 2 mg once daily for 3 days (alternative 400 mg 3 times a day for 5 days or 500 mg twice daily for 7-10 days)

Mepacine hydrochloride:
https://bnf.nice.org.uk/drug/mepacrine-hydrochloride.html

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8
Q

What is the first-line drug for the treatment of visceral leishmaniasis (kala-azar)?

A

Sodium stibogluconate (antimony compound)

Second line: amphotericin B (in combination or after sodium stibogluconate)

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9
Q

What is the management of cutaneous leishmaniasis if the skin lesions are NOT extensive or unsightly?

A

Nothing - lesions will heal spontaneously

If skin lesions are extensive or unsightly: sodium stibogluconate +/- amphotericin B (same as visceral leishmaniasis)

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10
Q

Amoebic abscesses of the liver require aspiration if… (3)

A
  1. Suspected that they may rupture
  2. No improvement after 72 hours of metronidazole treatment
  3. Abscess > 100 ml of pus

https://bnf.nice.org.uk/treatment-summary/antiprotozoal-drugs.html

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11
Q

If toxoplasmosis is acquired during pregnancy, what unlicensed drug may reduce the risk of transmission of maternal infection to the fetus?

A

Spiramycin

https://bnf.nice.org.uk/treatment-summary/antiprotozoal-drugs.html

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12
Q

What is the first-line treatment of toxoplasmosis in HIV/immunosuppressed patients?

A

Pyrimethamine + sulfadiazine for several weeks (> 6 weeks)

Alternatives:
Pyrimethamine + clindamycin
OR
Clarithromycin + azithromycin

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13
Q

If a patient is taking pyrimethamine for the treatment of toxoplasmosis, what investigation do they need to do weekly to watch out for adverse effects?

A

Weekly blood counts

Pyrimethamine is a folate antagonist, common side effects include leucopenia and thrombocytopenia

Patient should also take folinic acid supplements

https://bnf.nice.org.uk/drug/pyrimethamine.html

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14
Q

Metronidazole is an antimicrobial drug with high activity against … (2)

A
  1. Anaerobic bacteria
  2. Protozoa

https://bnf.nice.org.uk/drug/metronidazole.html

From top 100: metronidazole enters bacterial cells by passive diffusion. In anaerobic bacteria, the reduction of metronidazole generates a nitroso free radical. This binds to DNA, reducing synthesis and causing widespread damage, DNA degradation and cell death (bactericidal)

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15
Q

Which protozoal infections is metronidazole indicated for treatment? (3)

A
  1. Amoebiasis (invasive intestinal and extra-intestinal, including liver abscess)
    - Adult dose: 800 mg 3 times a day for 5 days in intestinal infection (for 5-10 days in extra-intestinal infection)
  2. Urogenital trichomoniasis
    - Adult dose: 200 mg 3 times a day for 7 days, alternatively 400-500 mg twice daily for 5-7 days, or 2 g for 1 dose
  3. Giardiasis
    - Adult dose: 2 g daily for 3 days, alternatively 400 mg 3 times a day for 5 days, alternatively 500 mg twice daily for 7-10 days

https://bnf.nice.org.uk/drug/metronidazole.html

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16
Q

What is the route of administration of metronidazole for the protozoal infections (amoebiasis, trichomoniasis and giardiasis)?

A

Oral

  1. Amoebiasis (invasive intestinal and extra-intestinal, including liver abscess)
    - Adult dose: 800 mg 3 times a day for 5 days in intestinal infection (for 5-10 days in extra-intestinal infection)
  2. Urogenital trichomoniasis
    - Adult dose: 200 mg 3 times a day for 7 days, alternatively 400-500 mg twice daily for 5-7 days, or 2 g for 1 dose
  3. Giardiasis
    - Adult dose: 2 g daily for 3 days, alternatively 400 mg 3 times a day for 5 days, alternatively 500 mg twice daily for 7-10 days
17
Q

What is the effect of drinking alcohol while taking metronidazole?

A

Disulfiram-like reaction

Symptoms: flushing, headache, nausea and vomiting

Avoid alcohol for at least 48 hours after stopping treatment

18
Q

What effect does metronidazole have on CYP enzymes?

A

Inhibitory effect

Reduces the metabolism of warfarin (increasing the risk of bleeding) - monitor INR and adjust dose

https://bnf.nice.org.uk/interaction/metronidazole-2.html#bnf_i1630548642590

19
Q

What happens when you combine metronidazole with lithium?

A

Metronidazole increases the concentration of lithium

20
Q

What are the neurological adverse effects of metronidazole at high doses or for a prolonged course?

A
  1. Peripheral neuropathy
  2. Optic neuropathy
  3. Seizures
  4. Encephalopathy
21
Q

Tinidazole is an antimicrobial drug with high activity against … (2)

A
  1. Anaerobic bacteria
  2. Protozoa

Same as metronidazole.

Tinidazole has a longer duration of action than metronidazole

https://bnf.nice.org.uk/drug/tinidazole.html

22
Q

What are the indications for tinidazole? (9)

A
  1. Anaerobic infections
  2. Bacterial vaginosis
  3. Acute ulcerative gingivitis
  4. Abdominal surgery prophylaxis
  5. Intestinal amoebiasis
  6. Amoebic involvement of liver
  7. Urogenital trichomoniasis
  8. Giardiasis
  9. Helicobacter pylori eradication

https://bnf.nice.org.uk/drug/tinidazole.html

23
Q

What are the indications of liposomal amphotericin B (AmBisome)? (4)

A
  1. Severe systemic or deep mycoses where toxicity precludes the use of conventional amphotericin B

2 Suspected or proven infection in febrile neutropenic patients unresponsive to broad-spectrum antibacterial

  1. Aspergillosis
  2. Visceral leishmaniasis (unresponsive to antimonial alone)
    https: //bnf.nice.org.uk/drug/amphotericin-b.html
24
Q

What is the route of admission of liposomal amphotericin B (AmBisome)?

A

IV infusion

25
Q

Why should you avoid rapid infusion of amphotericin B?

A

Risk of arrhythmias

https://bnf.nice.org.uk/drug/amphotericin-b.html

26
Q

What are the indications for pentamidine isetionate? (5)

A
  1. Pneumocystis jirovecii pneumonia (IV infusion)
    - 4 mg/kg once daily for at least 14 days
  2. Prophylaxis of Pneumocystis jirovecii pneumonia (inhalation of nebulised solution)
    - 300 mg every 4 weeks, alternatively 150 mg every 2 weeks
  3. Visceral leishmaniasis (deep IM injection)
    - 3-4 mg/kg once daily on alternate days, maximum total of 10 injections, course may be repeated
  4. Cutaneous leishmaniasis (deep IM injection)
    - 3-4 mg/kg 1-2 times a week
  5. Trypanosomiasis (deep IM injection or IV infusion)
    - 4 mg/kg once daily or on alternate days for 7-10 injections

https://bnf.nice.org.uk/drug/pentamidine-isetionate.html

27
Q

What supplement should a patient take if they are being treated for toxoplasmosis with pyrimethamine?

A

Folinic acid supplements

Pyrimethamine is a folate antagonist

28
Q

A patient with antimony-resistant visceral leishmaniasis is being treated with pentamidine isetionate. What is the route of administration?

A

Deep IM injection

3-4 mg/kg once daily on alternate days, maximum of 10 injections, course may be repeated if necessary

Roomies Collab Deck 1: Infectious Disease and CV (84 decks)

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