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Indications And Dose

Tapeworm infections (Taenia solium) ▶BY MOUTH ▶Adult: 5–10 mg/kg for 1 dose, to be taken after a light breakfast Tapeworm infections (Hymenolepis nana) ▶BY MOUTH ▶Adult: 25 mg/kg for 1 dose, to be taken after a light breakfast Schistosoma haematobium worm infections | Schistosoma mansoni worm infections ▶BY MOUTH ▶Adult: 20 mg/kg, followed by 20 mg/kg after 4–6 hours Schistosoma japonicum worm infections ▶BY MOUTH ▶Adult: 20 mg/kg 3 times a day for 1 day l UNLICENSED USE Praziquantel is an unlicensed drug.

Source page 663

Interactions

→Appendix 1: praziquantel

Source page 663

Medicinal Forms

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

Source pages 663, 664

Adults

First line only; read the complete Indications and dose section above.

5–10 mg/kg for 1 dose, to be taken after a light

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 663

Adults

First line only; read the complete Indications and dose section above.

25 mg/kg for 1 dose, to be taken after a light

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 663

Adults

First line only; read the complete Indications and dose section above.

20 mg/kg, followed by 20 mg/kg after 4–6 hours

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 663

Adults

First line only; read the complete Indications and dose section above.

20 mg/kg 3 times a day for 1 day

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 663

Indications And Dose

Source page 663

Interactions

→Appendix 1: praziquantel

Source page 663

Medicinal Forms

Source pages 663, 664

Adults

First line only; read the complete Indications and dose section above.

5–10 mg/kg for 1 dose, to be taken after a light

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 663

Adults

First line only; read the complete Indications and dose section above.

25 mg/kg for 1 dose, to be taken after a light

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 663

Adults

First line only; read the complete Indications and dose section above.

20 mg/kg, followed by 20 mg/kg after 4–6 hours

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 663

Adults

First line only; read the complete Indications and dose section above.

20 mg/kg 3 times a day for 1 day

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 663

praziquantel

Overview

Indications And Dose

Safety

Interactions

Dose and formulations

Medicinal Forms

Dose text by age group

praziquantel

Overview

Indications And Dose

Safety

Interactions

Dose and formulations

Medicinal Forms

Dose text by age group