Review of Pharmacology - 9E (2015)

Review of Pharmacology
Table Contd...
Short term chemoprophylaxis
(up
to 6 weeks)
Chemoprophylaxis
for longer
stay (more than 6
weeks)
Doxycycline (should be started 2 days before travel and continued for 4 weeks
after leaving the malarious area)
Melfoquine (should be administered two weeks before, during and four weeks
after exposure)
– The parenteral treatment in
severe malaria cases should be
given for mini mum of 24 hours
once started (irrespective of
the patient‘s ability to tolerate
oral medication earlier than 24
hours)
Doxycyline is not recommended
for pregnant women and children
less than 8 years.
Melfoquine is contraindicated in
individuals with history of convulsions,
neuropsychiatric problems
and cardiac conditions.
Treatment and Prophylaxis of Malaria (National guidelines according to NBVDCP)
The WHO Recommended ACTs include
Chemotherapy B: Antimicrobials for Specific Conditions
Metronidazole is the drug of
choice for
G – Giardiasis
Gardernella vaginalis
(Bacterial vaginosis)
U – Ulcer (Peptic ulcer)
(In combination therapy for
H. pylori)
P – Pseudomembranous colitis
by C. difficile
T – Trichomoniasis
A – Ameobiasis
(Anaerobic bacteria like
bacteroides and clostridium)
• Artemether-Lumefantrine
• Artesunate-Mefloquine
• Dihydroartemisinin-Piperaquine
Drugs for Amoebiasis
• Artesunate-Amodiaquine
• Artesunate-Sulfadoxine-Pyrimethamine
The drugs effective against infections of Entamoeba histolytica can be classified as:
• Tissue (extra-intestinal) amoebicides only e.g. Chloroquine.
• Both intestinal (luminal) and extra-intestinal amoebicides e.g. nitroimidazoles
(metronidazole, tinidazole secnidazole, ornidazole), emetine and dehydroemetine.
• Luminal amoebicides only e.g. diloxanide furoate, paromomycin, iodoquinol, quiniodochlor
and tetracyclines.
Nitroimidazoles
This group includes metronidazole and related drugs. These are effective orally as well as
i.v. and eliminated by hepatic metabolism. Nitro group of these drugs gets bioactivated (by
reduction) to form reactive cytotoxic products that damage DNA.
• Metronidazole is the drug of choice for intestinal wall disease and amoebic liver
abscess. It is usually combined with a luminal amoebicide for these indications.
It is not a very good drug for luminal amoebiasis because it is almost completely
absorbed in the proximal intestine and very little amount reaches the colon.
• Metronidazole is also the drug of choice for the treatment of trichomoniasis,
giardiasis, bacterial vaginosis and pseudomembranous colitis by C. difficile.
• It is also used for the treatment of infections caused by anaerobic bacteria like
bacteroides and clostridium, and in combination therapy H. pylori.
594
Diloxanide furoate is the drug of
choice for asymptomatic intestinal
amoebiasis
Nausea, metallic taste and abdominal cramps are the most common adverse effects. It can also cause
discolouration of urine, leucopenia and dizziness. Seizures can occur with the use of high
dose. Opportunistic fungal infections can occur in a patient on metronidazole. It can cause
disulfiram like reaction if used in patients taking alcohol. Metronidazole can potentiate the
anticoagulant effect of coumarins. Tinidazole, secnidazole, ornidazole and satranidazole
have similar potency and efficacy as metronidazole but are long acting (secnidazole has
longest half life). Satranidazole is devoid of metallic taste, neurological adverse effects as
well as disulfiram like reaction.
Diloxanide Furoate
It is the drug of choice for asymptomatic intestinal amoebiasis and is used with tissue
amoebicides for extra-intestinal infections. It is also the drug of choice for carriers. It can
cause flatulence as adverse effect.
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