Other tissues affected include the liver, leading to liver abscesses
Symptoms of amebiasis include diarrhea and abdominal pain
Asymptomatic intestinal infection in nonendemic areas is treated by luminal amebicides
Luminal amebicides include Diloxanide furoate, Iodoquinol, and Paramomycin
Therapy with a luminal amebicide is required in the treatment of all other forms of amebiasis
Amebic colitis is treated with Metronidazole plus a luminal amebicide
TTC and erythromycin are alternatives for moderate colitis
Dehydroemetine or emetine can also be used, but they are toxic
Extraintestinal infections are treated with metronidazole plus a luminal amebicide
For unusual cases where initial therapy with metronidazole fails, aspiration of abscess (liver) is done along with chloroquine and repeat metronidazole
Dihydroemetine or emetine are toxic alternative drugs for extraintestinal infections
Tissue amebicides for both intestinal and extraintestinal infections: Metronidazole, tinidazole, Emetine, Dihydroemetine
Chloroquine is used for extraintestinal infections only
Metronidazole is a 5-nitroimidazole derivative
Therapeutic uses include amebiasis, gardiasis, trichomoniasis, and severe infections due to anaerobic bacteria
In patients with peptic ulcer infected with H. pylori, combination therapy includes PPI, amoxicillin, clarithromycin, and metronidazole
Adverse effects of metronidazole include headache, nausea, metallic taste, dizziness, and a disulfiram-like effect
Disulfiram-like effect includes copious vomiting, flushing, palpitation, and headache
Metronidazole interacts with alcohol causing a disulfiram-like effect
Drug interactions include inhibition of oral anticoagulant inactivation, enhanced metabolism with phenobarbitone, and reduced metabolism with cimetidine
Tinidazole is similar to metronidazole but has a better toxicity profile and higher half-life
Diloxanide furoate is useful in the treatment of asymptomatic passers of cysts and in conjunction with metronidazole for intestinal and systemic amebiasis
Emetine and dehydroemetine inhibit protein synthesis by blocking chain elongation
Adverse effects include pain at the site of injection, transient nausea and vomiting, and cardiotoxicity
Trypanosomiasis refers to chronic diseases caused by Trypanosoma species
African sleeping sickness is caused by Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense
Suramine, pentamidine, enflornithine, and melarsoprol are used in the treatment of trypanosomiasis
Chaga's disease is caused by Trypanosoma cruzi and can lead to cardiomyopathy and megacolon
Therapy includes Nifurtimox and Benznidazole
Suramine is the first-line therapy for early hemolymphatic African trypanosomiasis
Adverse effects include immediate reactions like fatigue, nausea, and late reactions like fever and renal abnormalities
Pentamidine disrupts the synthesis of DNA, RNA, phospholipids, and proteins
Therapeutic uses include PCP/PJP, African sleeping sickness, and an alternative for leishmaniasis
Adverse effects include hypotension, hypoglycemia, pain at the injection site, rash, metallic taste, fever, and cardiac arrhythmias
Eflornithine irreversibly inhibits both mammalian and trypanosomal ornithine decarboxylase
Therapeutic uses include the treatment of T. brucei gambiense
Adverse effects include anemia, leukopenia, thrombocytopenia, alopecia, vomiting, and abdominal pain