Patient should be lying
down when receiving drug parenterally. Direct intravenous
injection should be avoided whenever possible and never
given rapidly; intramuscular injections should be deep and
preferably given into the buttock. For intravenous infusion,
reconstitute 300 mg with 3–5 mL Water for Injections
(displacement value may be significant), then dilute
required dose with 50–250 mL Glucose 5% or Sodium
Chloride 0.9%; give over at least 60 minutes.
Powder for injection (dissolved in water for injection)
may be used for nebulisation.
l HANDLING AND STORAGE Pentamidine isetionate is toxic
and personnel should be adequately protected during
handling and administration—consult product literature.
PDF page 660
There can be variation in the licensing of
different medicines containing the same drug.
Powder for solution for injection
▶Pentacarinat (Sanofi)
Pentamidine isetionate 300 mg Pentacarinat 300mg powder for
solution for injection vials | 5 vial P £158.86
Helminth infection
Helminth infections
Specialist centres
Advice on prophylaxis and treatment of helminth infections
is available from the following specialist centres:
(0121) 424 0357
Birmingham
Scotland
Contact local Infectious Diseases Unit
(0151) 705 3100
Liverpool
0845 155 5000 (treatment)
London
Threadworms
Anthelmintics are effective in threadworm (pinworms,
Enterobius vermicularis) infections, but their use needs to be
combined with hygienic measures to break the cycle of auto-
infection. All members of the family require treatment.
Adult threadworms do not live for longer than 6 weeks and
for development of fresh worms, ova must be swallowed and
exposed to the action of digestive juices in the upper
intestinal tract. Direct multiplication of worms does not take
place in the large bowel. Adult female worms lay ova on the
perianal skin which causes pruritus; scratching the area then
leads to ova being transmitted on fingers to the mouth, often
via food eaten with unwashed hands. Washing hands and
scrubbing nails before each meal and after each visit to the
toilet is essential. A bath taken immediately after rising will
remove ova laid during the night.
Mebendazole p. 640 is the drug of choice for treating
threadworm infection in patients of all ages over 6 months.
It is given as a single dose; as reinfection is very common, a
second dose may be given after 2 weeks.
Ascaricides (common roundworm infections)
Mebendazole is effective against Ascaris lumbricoides and is
generally considered to be the drug of choice.
Levamisole p. 640 [unlicensed] (available from ‘special-
order’ manufacturers or specialist importing companies) is
an alternative when mebendazole cannot be used. It is very
well tolerated.
Tapeworm infections
Taenicides
Niclosamide [unlicensed] (available from ‘special-order’
manufacturers or specialist importing companies) is the
most widely used drug for tapeworm infections and side-
effects are limited to occasional gastro-intestinal upset,
lightheadedness, and pruritus; it is not effective against
larval worms. Fears of developing cysticercosis in Taenia
solium infections have proved unfounded. All the same, an
antiemetic can be given before treatment and a laxative can
be given 2 hours after niclosamide.
Praziquantel p. 641 [unlicensed] (available from ‘special-
order’ manufacturers or specialist importing companies) is
as effective as niclosamide.
Hydatid disease
Cysts caused by Echinococcus granulosus grow slowly and
asymptomatic patients do not always require treatment.
Surgical treatment remains the method of choice in many
situations. Albendazole below [unlicensed] (available from
‘special-order’ manufacturers or specialist importing
companies) is used in conjunction with surgery to reduce the
risk of recurrence or as primary treatment in inoperable
cases. Alveolar echinococcosis due to E. multilocularis is
usually fatal if untreated. Surgical removal with albendazole
cover is the treatment of choice, but where effective surgery
is impossible, repeated cycles of albendazole (for a year or
more) may help. Careful monitoring of liver function is
particularly important during drug treatment.
Hookworms
Hookworms (ancylostomiasis, necatoriasis) live in the upper
small intestine and draw blood from the point of their
attachment to their host. An iron-deficiency anaemia may
occur and, if present, effective treatment of the infection
requires not only expulsion of the worms but treatment of
the anaemia.
Mebendazole has a useful broad-spectrum activity, and is
effective against hookworms. Albendazole [unlicensed]
(available from ‘special-order’ manufacturers or specialist
importing companies) is an alternative. Levamisole is also is
also effective in children.
Schistosomicides (bilharziasis)
Adult Schistosoma haematobium worms live in the genito-
urinary veins and adult S. mansoni in those of the colon and
mesentery. S. japonicum is more widely distributed in veins
of the alimentary tract and portal system.
Praziquantel [unlicensed] is available from Merck Serono
(Cysticide ®) and is effective against all human schistosomes.
No serious adverse effects have been reported. Of all the
available schistosomicides, it has the most attractive
combination of effectiveness, broad-spectrum activity, and
low toxicity.
Filaricides
Diethylcarbamazine [unlicensed] (available from ‘special-
order’ manufacturers or specialist importing companies) is
effective against microfilariae and adults of Loa loa,
Wuchereria bancrofti, and Brugia malayi. To minimise
reactions, treatment in adults and children over 1 month, is
commenced with a dose of diethylcarbamazine citrate on the
first day and increased gradually over 3 days. Length of
treatment varies according to infection type, and usually
gives a radical cure for these infections. Close medical
supervision is necessary particularly in the early phase of
treatment.
In heavy infections there may be a febrile reaction, and in
heavy Loa loa infection there is a small risk of
encephalopathy. In such cases specialist advice should be
sought, and treatment must be given under careful in-
patient supervision and stopped at the first sign of cerebral
involvement.
Ivermectin p. 640 [unlicensed] (available from ‘special-
order’ manufacturers or specialist importing companies) is
very effective in onchocerciasis and it is now the drug of
choice; reactions are usually slight. Diethylcarbamazine or
suramin should no longer be used for onchocerciasis because
of their toxicity.
Infection
Cutaneous larva migrans (creeping eruption)
Dog and cat hookworm larvae may enter human skin where
they produce slowly extending itching tracks usually on the
foot. Single tracks can be treated with topical tiabendazole
(no commercial preparation available). Multiple infections
respond to ivermectin, albendazole or tiabendazole
(thiabendazole) by mouth [all unlicensed] (available from
‘special-order’ manufacturers or specialist importing
companies).
Strongyloidiasis
Adult Strongyloides stercoralis live in the gut and produce
larvae which penetrate the gut wall and invade the tissues,
setting up a cycle of auto-infection. Ivermectin [unlicensed]
(available from ‘special-order’ manufacturers or specialist
importing companies) is the treatment of choice for chronic
Strongyloides infection in adults and children over 5 years.
Albendazole [unlicensed] (available from ‘special order’
manufacturers or specialist importing companies) is an
alternative given to adults and children over 2 years.
ANTHELMINTICS
PDF pages 660, 661
