Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Helminth
Infections
Dr.Rathnakar U.P
www.scribd.com
www.pharmacologyfordummies.blogspot.com
T.Solium
T.Saginata
E.Granulosus
A.Lumbricoides
Hook worm
Enterobius
Filariasis
Onchocerca volvulus
(blinding worm).
•Helminths (worms) are
multicellular organisms
•Infect very large numbers of
humans and cause a broad range
of diseases.
•1 billion people are infected with
intestinal nematodes,
•Millions are infected with filarial
nematodes, flukes, and tapeworms.
•Greater problem in domestic
animals.
•Many drugs, which are directed against a
number of different targets, are available to
treat helminthic infections.
•Developing world, the goal is control of
infection, - decreasing the transmission of
infection.
•In other cases, complete elimination of
parasites is the goal of therapy, although
this goal can be challenging with certain
helminthic infections, because of both
limited efficacy of drugs and frequent
reinfection after therapy in endemic areas.
Anthelmintics
Anthelmintics are drugs
That act either locally to expel worms
from the gastrointestinal tract or
Systemically to eradicate adult
helminths or developmental forms that
invade organs and tissues
Benzimidazoles
Thiabendazole. mebendazole & albendazole
Pyrantel pamoate
Piperazine
Levamisole
Diethylcarbamazine citrate
Ivermectin
Niclosamide
Praziquantal
Bephenium hydroxynapthoate
Metrifonate, Oxamniquine, Doxycycline
Benzimidazoles
Thiabendazole. mebendazole & albendazole
Antihelminthic action:
Inhibits microtubule synthesis.
Glucose transport
Albendazole
Broad-spectrum oral antihelminthic,
Drug of choice -hydatid disease and
cysticercosis.
Treatment of pinworm
Hookworm infections,
Ascariasis,
Trichuriasis,
Strongyloidiasis
Albendazole-Clinical Uses
Administered on an empty stomach
when used against intraluminal
parasites
With fatty meal when used against
tissue parasites.
Albendazole-Clinical Uses….
ASCARIASIS, TRICHURIASIS,
AND HOOKWORM AND
PINWORM
Adults and children older than 2
years -Ascariasis and hookworm
infections, -single dose of 400 mg
orally
Repeated for 2–3 days for heavy
ascariasis infections and in 2
weeks for pinworm infections
Albendazole-Clinical Uses….
HYDATID DISEASE
Medical therapy and adjunct to surgical removal or
aspiration of cysts
More active against Echinococcus granulosus than against
E multilocularis
400 mg twice daily with meals for 1 month
NEUROCYSTICERCOSIS
Antihelminthic therapy may not superior to therapy with
corticosteroids alone and may exacerbate neurologic
disease
Albendazole -drug of choice over praziquantel
Corticosteroids -given with the antihelminthic drug to
decrease inflammation caused by dying organisms
400mg bdx21 days
Mebendazole
MOA: same as earlier
Round
Hook 100mg BDx3days. No bowel preparation
Pin
Thiabendazole: Toxic[absorbed]
Only when others fail
Benzimidazole-Toxicity
Nausea, vomiting, loss of appetite, headache,
giddiness
Impairs alertness
Itching, abdominal pain, diarrhoea
Neurological symptoms, bradycardia,
hypotension & liver damage
Hypersensitivity reactions
Avoid in pregnancy, renal & hepatic disease
Expulsion of Ascaris from mouth or nose
Thiabendazole-Mebendazole-Albendazole
Not safe in pregnancy
Pyrantel Pamoate
First was introduced into veterinary practice
as a broad-spectrum anthelmintic directed
against pinworm, roundworm, and
hookworm infections
Lower cure rates in Necator infestation,
Strongyloidosis
Inactive against Trichuris
Antihelmintic Action
– Depolarizing neuromuscular blocking agent
– Persistent activation of nicotinic acetylcholine
receptors, which results in spastic paralysis of
the worm
– Also inhibits cholinesterases
DIETHYLCARBAMAZINE CITRATE[DEC]
DEC- Drug of choice - filariasis,
loiasis, and tropical eosinophilia
MOA- Immobilizes microfilariae and
alters their surface structure,
displacing them from tissues and
making them more susceptible to
destruction by host defense
mechanisms.
Against adult worms is unknown.
DEC-CLINICAL USES
Taken after meals
Wuchereria bancrofti, Brugia malayi,
Brugia timori, and Loa loa
Efficacy and lack of serious toxicity
50 mg -day 1,
50 mg TID-day 2,
100 mg TID - day 3,
2 mg/kg -TID/ day -complete the 2–3 week
Chemoprophylaxis (Yearly with
Albendazole)
DEC-Other uses
Tropical eosinophilia, orally 2 mg/kg
TID daily - 7 days
Mass treatment to reduce the
prevalence of W bancrofti infection-
DEC+Ivermectin+Albendazole
DEC-Toxicity
Mild and transient, include headache, malaise,
anorexia, weakness, nausea, vomiting, and
dizziness
Release of proteins from dying microfilariae[third
and twelfth days of treatment]
If lymphangitis-Delay tt to quiscent period
Severity varies indifferent species
Heavy loads of microfilariae- Eosinophilia,
Proteinuria , retinal hemorrhages, encephalopathy
Antihistaminics & Steroids for reactions
Mazzotti reaction
Patients with onchocerciasis:
– Typically occurs within a few hours
after the first dose
– Intense itching, enlargement and
tenderness of the lymph nodes, and
papular rash, fever, tachycardia,
arthralgias, and headache.
– This reaction persists for 3 to 7 days
and then subsides, after which high
doses sometimes can be tolerated
Niclosamide
Second-line drug for the treatment of most
tapeworm infections,
Antihelminthic Actions:Adult worms (but not ova)
killed, -inhibition of oxidative phosphorylation or
stimulation of ATPase activity
Clinical Uses
The adult dose of niclosamide is 2 g once, given in
the morning on an empty stomach.
The tablets must be chewed thoroughly and then
swallowed with water
Niclosamide- ADE
Transitory adverse events include nausea,
vomiting, diarrhea, and abdominal discomfort.
Alcohol should be avoided on the day of treatment
and for 1 day afterward.
Safety not established in pregnancy or for children
younger than 2 years of age.
PIPERAZINE
Piperazine is an alternative for the treatment of ascariasis,
Piperazine-paralysis of ascaris by blocking acetylcholine at
the myoneural junction;
GABA-receptor agonist
↑ chloride ion conductance hyperpolarization & reduced
excitability muscle relaxation and flaccid paralysis
Tape worm
Guinea worms
Hydatid cyst