TREATMENTS Flashcards
E. HISTOLYTICA TREATMENT
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
TREATMENT OF PAM
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
ACANTHAMOEBA INFECTION TREATMENT:
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.
Giardiasis treatment
①Nitroimidazole derivatives
- Metronidazole (Flagyl) – contraindicated in pregnancy???
- Tinidazole
➁Acridine dye
- Atabrine (quinacrine)
③Nitrofurans
- Furazolidone
Treatment of T. vaginalis:
- 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%)
How’s malaria generally traeted?
- Supportive treatment, anti-malarial drugs
Which plasmodium species are mostly treated on an outpatient basis?
- 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
For simple or uncomplicated malaria in adults, First Line Drug:
- CoartemR ( Artemisinine Based Combination Therapy = ABCT, ACT) e.g.
=Artemether 20mg + Lumefantrine 120mg (AL)
For simple or uncomplicated malaria in adults, Second Line Drugs:
- Oral Quinine 300mg tablet
- Quinine 10mg/kg – IM diluted in saline or water for
injection
For severe or complicated malaria in adults:
- 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
Uncomplicated malaria Tx in pregnant women
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
Severe malaria Tx in pregnant women
=Quinine is 1st Line in this case
=Injectable artesunate 2.4mg/kg BW in 2nd and 3rd trimesters
Intermittent preventive treatment(IPT) in Pregnant women
– 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
For simple or uncomplicated malaria in children, First Line Drug:
=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
For simple or uncomplicated malaria in children, Second Line Drugs:
- Quinine 10mg/kg BW diluted in saline (IM)
For severe or complicated malaria in Children
- Injectable artesunate 2.4mg/kg BW IV or IM
- Quinine 20mg/kg BW diluted in dextrose (IV)
Treatment of stage 1 trypanosomiasis
=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
Treatment of stage 2 trypanosomiasis
=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.
Fexinidazole in Trypanosomiasis
- 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.
Treatment of Chagas disease
- 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.