There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: tablet
Tablet
▶Praziquantel (Imported (Germany))
Praziquantel 600 mg Biltricide 600mg tablets | 6 tablet P s
Praziquantel 150 mg Cesol 150mg tablets | 6 tablet P s
Praziquantel 500 mg Cysticide 500mg tablets | 90 tablet P s
Protozoal infection
Antiprotozoal drugs
Amoebicides
Metronidazole p. 572 is the drug of choice for acute invasive
amoebic dysentery since it is very effective against vegetative
forms of Entamoeba histolytica in ulcers. Tinidazole p. 574 is
also effective. Metronidazole and tinidazole are also active
against amoebae which may have migrated to the liver.
Treatment with metronidazole (or tinidazole) is followed by
a 10-day course of diloxanide furoate.
Diloxanide furoate is the drug of choice for asymptomatic
patients with E. histolytica cysts in the faeces; metronidazole
and tinidazole are relatively ineffective. Diloxanide furoate is
relatively free from toxic effects and the usual course is of
10 days, given alone for chronic infections or following
metronidazole or tinidazole treatment.
For amoebic abscesses of the liver metronidazole is
effective; tinidazole is an alternative. Aspiration of the
abscess is indicated where it is suspected that it may rupture
or where there is no improvement after 72 hours of
Infection
metronidazole; the aspiration may need to be repeated.
Aspiration aids penetration of metronidazole and, for
abscesses with more than 100 mL of pus, if carried out in
conjunction with drug therapy, may reduce the period of
disability.
Diloxanide furoate is not effective against hepatic
amoebiasis, but a 10-day course should be given at the
completion of metronidazole or tinidazole treatment to
destroy any amoebae in the gut.
Trichomonacides
Metronidazole is the treatment of choice for Trichomonas
vaginalis infection. Contact tracing is recommended and
sexual contacts should be treated simultaneously. If
metronidazole is ineffective, tinidazole may be tried.
Antigiardial drugs
Metronidazole is the treatment of choice for Giardia lamblia
infections. Alternative treatments are tinidazole or
mepacrine hydrochloride p. 527.
Leishmaniacides
Cutaneous leishmaniasis frequently heals spontaneously but
if skin lesions are extensive or unsightly, treatment is
indicated, as it is in visceral leishmaniasis (kala-azar).
Leishmaniasis should be treated under specialist
supervision.
Sodium stibogluconate p. 642, an organic pentavalent
antimony compound, is used for visceral leishmaniasis. The
dosage varies with different geographical regions and expert
advice should be obtained. Some early non-inflamed lesions
of cutaneous leishmaniasis can be treated with intralesional
injections of sodium stibogluconate under specialist
supervision.
Amphotericin p. 629 is used with or after an antimony
compound for visceral leishmaniasis unresponsive to the
antimonial alone; side-effects may be reduced by using
liposomal amphotericin (AmBisome ®). Abelcet ®, a lipid
formulation of amphotericin, is also likely to be effective but
less information is available.
Pentamidine isetionate p. 637 has been used in antimony-
resistant visceral leishmaniasis, but although the initial
response is often good, the relapse rate is high; it is
associated with serious side-effects. Other treatments
include paromomycin [unlicensed] (available from ‘special-
order’ manufacturers or specialist importing companies).
Trypanocides
The prophylaxis and treatment of trypanosomiasis is difficult
and differs according to the strain of organism. Expert advice
should therefore be obtained.
Toxoplasmosis
Most infections caused by Toxoplasma gondii are self-
limiting, and treatment is not necessary. Exceptions are
patients with eye involvement (toxoplasma
choroidoretinitis), and those who are immunosuppressed.
Toxoplasmic encephalitis is a common complication of
AIDS. The treatment of choice is a combination of
pyrimethamine p. 656 and sulfadiazine p. 596, given for
several weeks (expert advice essential). Pyrimethamine is a
folate antagonist, and adverse reactions to this combination
are relatively common (folinic acid supplements and weekly
blood counts needed). Alternative regimens use
combinations of pyrimethamine with clindamycin p. 564 or
clarithromycin p. 567 or azithromycin p. 566. Long-term
secondary prophylaxis is required after treatment of
toxoplasmosis in immunocompromised patients;
prophylaxis should continue until immunity recovers.
If toxoplasmosis is acquired in pregnancy, transplacental
infection may lead to severe disease in the fetus; specialist
advice should be sought on management. Spiramycin
Infection
[unlicensed] (available from ‘special-order’ manufacturers or
specialist importing companies) may reduce the risk of
transmission of maternal infection to the fetus.
5.1 Leishmaniasis
Other drugs used for Leishmaniasis Amphotericin, p. 629.
Pentamidine isetionate, p. 637
ANTIPROTOZOALS › OTHER
PDF pages 663, 664
