Amebicidal, anti-trypanomiasis, anti-leshmaniasis

• Amebiasis is an infestation with E. hystolytica
• Principal site of infestation is the intestine
• 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
• Luminal amebicides: Diloxanide, Idoquinol, Paramomycin
• 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