Drugs used in other Protozoal infections.pptx

Drugs used in protozoal infections

1. Drugs used in other Protozoal infections Pradyumna M Athreyas 2nd year MBBS, NMCRI

2. Protozoal infections Amoebiasis Giardiasis Trichomoniasis Leishmaniasis Cutaneous Leishmaniasis Mucocutaneous Leishmaniasis Visceral Leishmaniasis (Kala Azar)

3. Drugs used in Kala Azar –NVBDCP Amphotericin B Miltefosine Paramomycin Sodium Stibogluconate( SSG) (or Meglumine Antimonate- in French speaking countries of Latin and south America) Pentamidine –used 20 years back but not now Ketoconazole Allopurinol ONLY CONFIRMED CASES (BY RAPID DIAGNOSIS TEST OR SPLENIC ASPIRATE EXAM) ARE TO BE TREATED

4. Vector – Female Phlebotomine sand flies

5. Visceral Leishmaniasis (VL) Most serious form of Leishmaniasis caused by Leishmania Donovani Occurs mainly in Tropical and sub- tropical areas According to latest (2019) WHO estimate 50,000 - 90,000 cases annualy In treating Leishmaniasis geographic location is important because the species causing VL and its responsiveness to different drugs differs between different regions of the world In India the parasite is resistant to Sodium Stibogluconate which is the first line drug of treatment in many other countries

6. SODIUM STIBOGLUCONATE( SSG) First line drug for VL in most part of the world NO LONGER EFFECTIVE IN NEPAL AND INDIA DUE TO DRUG RESISTANCE > 90% cure rate Still used in East africa, Central asia, Mediterranian Basin and south americ a

7. Mechanism of Action SSG is a water soluble pentavalent antiomonial Antimony inhibits SH dependant enzymes bioenergetics of the parasite is interfered with Specific reductase enzyme present in the L. amastigots, reduces pentavalent Sb of SSG to the toxic trivalent form, This promotes efflux of glutatione and other reduced thiols from the parasite residing in macrophages, exposing them to oxidative damage

8. Pharmacokinetics and ADR PK: Rapidly absorbed from the deep IM site and excreted unchanged in urine within 6-12 hours A small fraction enters tissues and remain stored for long periods. Repeated dose is cumulative ADR: Nausea, vomiting, metallic taste, cough , pain abdomen, pain and stiffness in inj. muscle, sterile abscess, QT prolongation, arrhythmias, shock and death. 20mg/kg i.m. or slow i.v. daily for 30 days

9. Miltefosine Derivative of alkyl phosphocholine Potent antileishmania activity First orally active drug against kala azar First line of drug under NVBDCP Available only through NVBDCP Four week course has achieved >95% cure rate in India and other countries

10. Mechanism of Action Mechanism of action unknown Studies suggest that it interferes with lipid metabolism of parasite, or prevent the synthesis of some critical cell surface anchor molecule, or alter signal transduction Resistance may develop. SO, COMBINATION THERAPY WITH PARAMOMYCIN OR AMPHOTERICIN B IS BEING PROMOTED

11. Pharmacokinetics and ADR Rapidly absorbed in the body, and widely distributed Long acting drug with biphasic elimination Plasma half life: early phase- 1 week, terminal phase - 4 weeks ADR: Anorexia, nausea, vomiting, diarrhea, skin allergy, rise in hepatic transaminases(AST, ALT), teratogenic effect C/I: Miltefosine is contraindicated in pregnant women due to teratogenic effect. When miltefosine is given it should be ensured that the female patients do not get pregnant during and till 3 months after miltefosine course

12. THANK YOU