TREATMENTS

Question 1

E. HISTOLYTICA TREATMENT

Answer 1

①Luminal amoebicides: These include Iodoquinol, paromomycin, & tetracycline which act in the intestinal lumen but not in tissues.
➁Tissue amoebicides: Are effective in systemic infections but less effective in the intestine. Examples include emetine, chloroquine．
③Luminal & tissue amoebicides: Metronidazole and related compounds like tinidazole and ornidazole act on both sites and are
the drug of choice for treating amoebic colitis and amoebic liver
abscess.

Note: Metronidazole & tinidazole act on both sites but non of them reach high levels in the gut lumen hence patients with amoebic colitis or amoebic liver abscess should also receive a luminal agent

Question 2

TREATMENT OF PAM

Answer 2

①Amphotericin-B is the drug of choice administered via IV or intrathecally (injected into the spinal canal or subarachnoid space).
➁Treatment combining miconazole & sulfadiazine has shown limited
success when administered early.
* More than 95% cases of PAM are fatal despite of treatment

Question 3

ACANTHAMOEBA INFECTION TREATMENT:

Answer 3

①ACANTHAMOEBA KERATITIS, current therapy involves topical administration of biguanide or chlorhexadine with or without diamidine agent.
* In severe cases, where vision is threatened, penetrating keratoplasty
can be done.
➁No effective treatment is available for GAE. Multidrug combinations
including pentamidine, sulfadiazine, rifampicin, and fluconazole are
being used with limited success.

Question 4

Giardiasis treatment

Answer 4

①Nitroimidazole derivatives
- Metronidazole (Flagyl) – contraindicated in pregnancy???
- Tinidazole
➁Acridine dye
- Atabrine (quinacrine)
③Nitrofurans
- Furazolidone

Question 5

Treatment of T. vaginalis:

Answer 5

• Single dose of Metronidazole 2 gm once or metronidazole PO 500 mg TDS for 7 days
• Metronidazole is contraindicated in pregnancy due to its mutagenecity, so topical therapy with clotrimazole is applied
• Simultaneous treatment of both partners is recommended
• Tinidazole is an alternate drug
• Prognosis a full recovery (100%)

Question 6

How’s malaria generally traeted?

Answer 6

• Supportive treatment, anti-malarial drugs

Question 7

Which plasmodium species are mostly treated on an outpatient basis?

Answer 7

• P. vivax, P. ovale, and P. malariae
• P. falciparum pts are generally admitted for observation
  of any complications
  – hospitalized until they are improving clinically and
  parasite count is declining
  – most can be treated with oral therapy→ severe
  malaria requires IV therapy/ICU

Question 8

For simple or uncomplicated malaria in adults, First Line Drug:

Answer 8

• CoartemR ( Artemisinine Based Combination Therapy = ABCT, ACT) e.g.
  =Artemether 20mg + Lumefantrine 120mg (AL)

Question 9

For simple or uncomplicated malaria in adults, Second Line Drugs:

Answer 9

• Oral Quinine 300mg tablet
• Quinine 10mg/kg – IM diluted in saline or water for
  injection

Question 10

For severe or complicated malaria in adults:

Answer 10

• Injectable artesunate 2.4mg/kg body weight IV/IM
• If unavailable artemether (IM) or Quinine 20mg/kg
  (IV/IM) diluted in 5% or 10% dextrose

Question 11

Uncomplicated malaria Tx in pregnant women

Answer 11

First line
=Oral Quinine in 1st Trimester (can be used in all trimesters)
=Injectable artesunate 2.4mg/kg BW in 2nd and 3rd trimesters

• In absence of Quinine, =Artemether 20mg+Lumefantrine 120mg can be used in 1st trimester

Question 12

Severe malaria Tx in pregnant women

Answer 12

=Quinine is 1st Line in this case
=Injectable artesunate 2.4mg/kg BW in 2nd and 3rd trimesters

Question 13

Intermittent preventive treatment(IPT) in Pregnant women

Answer 13

– Sulphadoxine + Pyrimethamine given 16 weeks following last monthly period (LMP)
* 2 consecutive doses given at least 16 weeks apart during the 2
nd and 3rd trimester
* A total of 3 doses should be given during the entire duration of pregnancy

Question 14

For simple or uncomplicated malaria in children, First Line Drug:

Answer 14

=CoartemR ( Artemisinine Based Combination Therapy = ABCT, ACT) for children above 5kg
* Artemether 20mg+ Lumefantrine 120mg (AL)
* Sulphadoxine 500mg + Pyrimethamine 25mg – single
treatment of half a tablet

Question 15

For simple or uncomplicated malaria in children, Second Line Drugs:

Answer 15

• Quinine 10mg/kg BW diluted in saline (IM)

Question 16

For severe or complicated malaria in Children

Answer 16

• Injectable artesunate 2.4mg/kg BW IV or IM
• Quinine 20mg/kg BW diluted in dextrose (IV)

Question 17

Treatment of stage 1 trypanosomiasis

Answer 17

=pentamidine is the drug of choice for gambiense HAT
=suramin is the drug of choice for rhodesiense HAT.

• Pentamidine dose is 3–4 mg/kg body weight, im daily for 7–10 days.
  Suramin dose is 20 mg/kg body weight in a course of 5 injections iv at an interval of 5–7 days.
• Suramin does not cross the blood brain barrier & is nephrotoxic

Question 18

Treatment of stage 2 trypanosomiasis

Answer 18

=melarsoprol (MelB) is the drug of choice-can cross the blood brain barrier.
*Dose: 2–3 mg/kg/per day
(max. 40 mg) for 3–4 days.

Question 19

Fexinidazole in Trypanosomiasis

Answer 19

• An oral treatment for gambiense HAT for stage I & II.
  *Its indicated as the first line for 1st & non-severe 2nd stage.

Currently a clinical trial for its use in rhodesiense HAT is ongoing.

Question 20

Treatment of Chagas disease

Answer 20

• No effective specific treatment
• Nifutrimox and benznidazole have been used with some success in both acute and chronic Chagas disease.
• These drugs kill only the extracellular forms but not the intracellular forms.
• Dose: Nifutrimox: 8–10 mg/kg for adults and 15 mg/kg for children.
• The drug should be given orally in 4 divided doses each day for 90–120 days.
• Benznidazole: 5–10 mg/day orally for 60 days.
• Anti-failure medication is used for cases of cardiac myopathy.
• Surgical intervention is indicated where required.