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Parasitic Infections (1 of 14)

Parasitic Infections (1 of 14)

Parasitic (1 of 14)

1 Patient presents w/ signs & symptoms suggestive of GI parasitic

2 DIAGNOSIS No ALTERNATIVE Is a GI parasitic infection DIAGNOSIS confi rmed?

Yes

Protozoal or helminthic infection?

Protozoal Infection Helminthic Infection

A Rehydration & nutrition B Prevention

PHARMACOLOGICAL PHARMACOLOGICAL THERAPY FOR THERAPY FOR PROTOZOAL HELMINTHIC INFECTIONS INFECTIONS ©See page 3 MIMSSee page 3

B1 © MIMS 2019 PARASITIC INFECTIONS • ofStools Exam Microscopic TestsLab • • • • • Findings Exam Physical • • • • • Infections Parasitic GI Factors in Susceptibility Host • • History Clinical • • Nonspecific Symptoms • Symptoms GI • • Tests Lab Other - Fundamental ofallGIinfections tothe diagnosis prolapse Rectal Ileus Ascites Hepatomegaly Pallor Presence ofamalignancy Immunosuppressive drugs Pregnancy Intercurrent disease statusNutritional ofpatients inthe ishelpful diagnosis ofparasites distribution ofthe geographic Knowledge source water, ofdrinking meat, water endemic where may infresh certain be parasites swimming eating undercooked eg forhelminthic infections, especially Attempt exposure, ofpossible toelicit ahistory patientsSome asymptomatic may be &pruritus edema loss, Fever, wt sweating, anorexia, fatigue, malaise, , fl pain,, Abdominal obstruction atulence, ofbiliary symptoms malabsorption, - Anemia & eosinophilia may be seen onthe count complete seen may blood (CBC) be Anemia &eosinophilia studies Barium - Cellophane test tape - chain (PCR) reaction polymerase immunosorbent (ELISA), assay Enzyme-linked - Immunofluorescent test antibody - test capsule String - Biopsy - aspirate Duodenal -  infection: todocument aGIparasitic that are other used efollowing may tests be -

technique, should be used shouldbe technique, usingaconcentration personnel trained by examined &apermanent stain specimens, A minimum of3stool worms  oradult larvae proglottids, helminth &trophozoites, ova, protozoan cysts todetect isused exam estool A fecal sample must be mixed well before examination because eggs are never uniformly distributed infeces distributed uniformly are never eggs well sample examination before because mixed mustA fecal be 1

© MIMS INFECTIONS PARASITIC GI OF &SYMPTOMS SIGNS Parasitic Infections(2of14) 2 DIAGNOSIS B2 © MIMS 2019 PARASITIC INFECTIONS Cplaiss philippinensis (Capillariasis) Capillaria (Hookworms) , , (Ancylostomiasis) americanus Necator Ancylostoma duodenale, () lumbricoides Ascaris (Roundworms) Nematodes Diphyllobothrium latum caninum, Diphyllobothrium Taenia Taenia saginata, solium, (Tapeworms) Cestodes or sp() Giardia lamblia () Giardia lamblia • () E histolytica • (Amoebiasis) E histolytica • (Amoebiasis) histolytica Severe intestinal disease orliver abscess intestinal disease Severe Mild-moderate intestinal disease passer cyst Asymptomatic C Pathogen Pathogen © MIMS RECOMMENDED THERAPY FOR PROTOZOAN PARASITES D Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not RECOMMENDED THERAPY FOR HELMINTHS Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Parasitic Infections(3of14) PROTOZOAL INFECTIONS HELMINTH INFECTIONS HELMINTH pamoate Pyrantel Mebendazole or Albendazole, Mebendazole orNitazoxanide +Azithromycin are treated ofgiardiasis carriers or asymptomatic notrequire treatment. Innonendemic areas, does & isself-limiting immunocompetent giardiasis In most patients, or Secnidazole orTinidazole Metronidazole orTinidazole Metronidazole orParomomycin Iodoquinol Preferred Agents Preferred Agents B3 Drug Drug Albendazole pamoate Pyrantel or Levamisole, Secnidazole orTinidazoleSecnidazole Paromomycin, Quinacrine, Ornidazole, Nitazoxanide, ,Albendazole, or furoate Alternative Agents Alternative Agents -

© MIMS 2019 PARASITIC INFECTIONS • TransfusionBlood &Treatment w/ FeSO • Losses &Electrolyte ofFluid Replacement • • Hydration &NutritionAdequate (Strongyloidiasis) stercoralis Strongyloides  readworm) (Pinworm or Enterobius vermicularis (Roundworms) Nematodes orPraziquantel Albendazole sinensisClonorchis (Oriental liver fluke) Trematodes (Flukes) Trichuris trichiura Trichuris (Intestinal flukes) Metagonimusheterophyes yokogawai Heterophyes Fasciolopsis buski, (Fascioliasis) Fasciola hepatica liver fluke) Asian (Southeast viverrini Opisthorchis Schistosoma japonicumSchistosoma Praziquantel haematobiumSchistosoma Paragonimus (Lung fl westermani ukes) Schistosoma mansoniSchistosoma  anemia which may severe infections cause inhookworm necessary may be measures ese Vomiting infl result &diarrhea mainly Na&K losses, uid &electrolyte Ensure that patient’s nutritional &hydration status are at maintained acceptable levels malnutrition frequentlyPatients infections suff w/parasitic in resulting vomiting&diarrhea, er malabsorption, from Pathogen D (Whipworm) © MIMS RECOMMENDED THERAPY FOR HELMINTHS (CONT’D) Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing A REHYDRATION & NUTRITION Parasitic Infections(4of14) • Mebendazole or iabendazole Ivermectin, Albendazole, pamoate Pyrantel Mebendazole or Albendazole, Mebendazole rcaedzl Nitazoxanide Praziquantel orTriclabendazole Albendazole orPraziquantel Albendazole Praziquantel Praziquantel Praziquantel parasite, ifnecessary parasite, document eradication of lab to exams Repeat INFECTIONS FOLLOWUP HELMINTH HELMINTH Preferred Agents B4 Drug Piperazine Nitazoxanide or Ivermectin Albendazole, Bithionol Alternative Agents - - - - - © MIMS 2019 PARASITIC INFECTIONS • • • • • Amoebicides Luminal forTreatmentDrugs ofAmoebiasis • • • • • • • • () Quinacrine • Nitazoxanide • • • Furazolidone • Drugs Antiprotozoan Other • • • • Tissue Amoebicides - - Paromomycin treatment relapse isfrequent w/aluminalamoebicide ismandatory, otherwise further treatment orliver abscess, after foramoebic dysentery persists carriage cyst When asymptomatic To spread prevent secondary - To disease avoid invasive the ofdeveloping risk - passers cyst forasymptomatic Recommended infection inpatients Ehistolytica w/asymptomatic used May be -  agents ese are eff intreating organisms lumenective in the bowel ParomomycinEg Diloxanide Iodoquinol, furoate, ofparasites forms tokillinfective ofhumanCompost waste material toavoid fecal contamination by orwater crops supplies &wastewater offood ofsewage disposal Proper enterobiasis eg infections Targeted contacts liketreating chemotherapy family ofapatient may w/certain prevent infections, parasitic route ofinfection toinhibitthe soil-to-skin Use offootwear Meat &fi properlysh must cooked be - frequently Kitchen utensils washed must be - transmission fecal-oral interrupt to consumption before Good foodhygieneegwashingallvegetables&fruits route oftransmissionmany parasites orurinary-oral tointerrupt the fecal-oral Handwashing hygiene, oftransmission&prevention oftransmission routes personal regarding Health education translation &protein thereby transcription DNA inhibitingRNA actionisbindingtoparasite Suggested Action: sp &trophozoites ofGlamblia ofCryptosporidium &oocysts ofsporozoites growth Inhibits Action: damage tointracellular Causes Action: components Furazolidone eff isas inthe Metronidazole treatment as ofgiardiasis ective forthe treatmentUsed ofgiardiasis Eg Furazolidone, Quinacrine Nitazoxanide, impaired template function helical structure instrandbreakage resulting & DNA damage cause toparasite derivatives growth parasite’s raises italso its internal pH,restricting polymerase; &RNA DNA binds&inhibits Chloroquine lumen bowel  agents ese are eff eff butare less amoebiasis intreating invasive ective intreating organismsective inthe &) Secnidazole Ornidazole, , (Metronidazole, Eg derivatives &Nitroimidazole Chloroquine &giardiasis intreatment used ofcryptosporidiosis be May also -

© MIMSTemporarily eliminates inhuman diarrhea immunodefi patients whohave cryptosporidiosis (HIV) ciency interfering protein w/bacterial subunits synthesis to 30sribosomal binds &pathogenic normal against directly onamoebaw/antibacterialActs activity organisms inGItract; C Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not TREATMENT FOR PROTOZOAL INFECTIONS Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Parasitic Infections(5of14) B PREVENTION B5 © MIMS 2019 PARASITIC INFECTIONS • •  iabendazole • • pamoate Pyrantel • • • Praziquantel • Piperazine • • Oxamniquine • Niclosamide • • Metrifonate • • • Mebendazole • Levamisole • • Ivermectin • • Bithionol • • • Albendazole Drugs Anthelminthic High frequency ofuntoward effHigh frequency &the availability ofalternative agentsects usefulness its have limited intissues forms Active many against &larval intestinal adultnematodes acetylcholine eff Blocks Action: at neuromuscular junction causing muscleects paralysis &pinworm) forthe treatmentUsed hookworm (roundworm, ofintestinal nematodes resistanceDrug isapossibility, chemotherapy incountries esp practicingmass acontrol as measure cell inhelminths permeability Action: Increases ofintracellular w/loss ofmusculature ¶lysis calcium of choice Drug forliver flukes - Highly eff ofcestodes form adult&larval spthat humans, allSchistosoma against infect ective acetylcholine eff Blocks Action: at neuromuscular junction causing muscleects paralysis anymore eggs release butcannot tomesentery return Action: onlyforSmansoni infection Used of tapeworms &segments ofhead necrosis Causes Action: acetylcholinesterase Inhibits Action: Alternative toPraziquantel inthe treatment ofShaematobium infection glucose andnutrient worms insusceptible uptakeirreversibly Blocks Action: ofsideeff the frequency from inalow GItractresulting Poorly absorbed ects Widely fortreatment used ofintestinal nematodes muscle worms insusceptible paralysis Causes Action: cells toparalysis leading ofmuscle ofparasite &nerve hyperpolarization Causes Action: effAs  as ective untowardeff Sstercoralis against fewer iabendazole buthas ects &GIsymptoms reactions photosensitivity antigens ofworm urticaria, may eg Release reactions cause Fhepatica agent for Preferred ATPDecreases inworms production Widely forintestinal nematode infections used activity ofantiparasitic anexceptionallyHas broad spectrum

© MIMS fl blood Causes uke totransfer veins mesenteric from tothe liver where females the are retained; males D Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not TREATMENT FOR HELMINTHIC INFECTIONS Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Parasitic Infections(6of14) B6 © MIMS 2019 PARASITIC INFECTIONS Albendazole Ivermectin Derivative Drug Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All

© MIMS 24hrly x3days 400 mgPO Tapeworm infection: asingledose as 400 mgPO T trichiura: 24hrly x3days 400 mgPO Strongyloidiasis: 12hrly x3days 400 mgPO : O viverrini asingledose as 400 mgPO Hookworms: 24hrly x5days 400 mgPO Giardiasis: in 2wk repeat asingledose; as 400 mgPO Enterobiasis: 12hrly x3days 400 mgPO : C sinensis 12hrly x20-30days 200 mgPO Capillariasis: asingledose as 400 mgPO Ascariasis: x1-2days PO 200mcg/kg/day Strongyloidiasis: Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage Parasitic Infections(7of14) Dosage Guidelines B7 • Instructions Special • Reactions Adverse • Instructions Special • • Reactions Adverse impairment Use w/caution inpatients w/hepatic headache pain, abdominal liver transaminases, Elevated doses repeated after esp reactions monitor foradverse to administration; may after need Supervision depression) CNS drowsiness, GI eff eff CNS (N/V), ects (headache, ects lymphadenopathy, irritation mildocular edema, Fever, myalgia, arthralgia, pruritus, Remarks © MIMS 2019 PARASITIC INFECTIONS Bithionol Bisphenol ( iabendazole) Mebendazole (Cont’d) Benzimidazoles Drug Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All

© x5days30-50 mg/kg/day PO or for atotalof10-15doses onalternate days 30-50 mg/kgPO : P westermani for atotalof10-15doses onalternate days 30-50 mg/kgPO MIMS: F hepatica 12hrly x2-3days 25 mg/kgPO Strongyloidiasis: asingledose as 500-600 mgPO 12hrly x3days 100 mgPO T trichiura: asingledose as 500 mgPO 12hrly x3days 100 mgPO Strongyloidiasis: asingledose as 500-600 mgPO 12hrly x3days 100 mgPO Hookworms: in 2wk repeat asingledose; as 100 mgPO Enterobiasis: 12hrly x20-30days 200 mgPO Capillariasis: dose asingle as 500-600 mgPO 12hrly x3days 100 mgPO Ascariasis: Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage ANTHELMINTICS (CONT’D) ANTHELMINTICS Parasitic Infections(8of14) Dosage Guidelines B8 • • Reactions Adverse • • Instructions Special • • Reactions Adverse • • Instructions Special • • Reactions Adverse photosensitivity reactions photosensitivity skinrashes, headache, Dizziness, diarrhea) discomfort, GI eff N/V, (anorexia, ects abdominal oroperate machinery shouldnotdrive drug patients takingthe May drowsiness; cause impairment Use w/ caution inpatients w/hepatic orrenal hyperglycemia; leukopenia Disturbance ofcolor tinnitus; vision; drowsiness fatigue, headache, skinrashes; parenchymal damage; pruritus, or pain);liverabdominal cholestasis N/V, (anorexia, GI symptoms diarrhea, treatment during function &liver countMonitor complete blood (CBC) impairment Use w/caution inpatients w/hepatic depression marrow bone alopecia, liver enzymes, elevated Allergic reactions, dizziness headache, pain,diarrhea; Abdominal Remarks © MIMS 2019 PARASITIC INFECTIONS Praziquantel Derivative Prazino- Piperazine Other Metrifonate Compound Organophosphorus Drug Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All

© asingledose as 5-25 mg/kgPO Tapeworms: asingledose as 40 mg/kgPO 4-6hrly x3doses 20 mg/kgPO MIMSSchistosomiasis: 8hrly x1-2days 25 mg/kgPO Lung fluke: asingledose as 40 mg/kgPO 8hrly x1-2days 25 mg/kgPO Opisthorchiasis: 40 mg/kgsingledose 8hrly x1-2days 25 mg/kgPO flIntestinal ukes: 8hrly x1-2days 25 mg/kgPO Chlonorchiasis: 7days ifneeded after repeat may 24hrly x7days, 2.25 gPO Enterobiasis: once 14days repeat after then asingledose, as 4.5 gPO Ascariasis: 2wkapart given dose each x3doses, PO 7.5-10 mg/kg/dose : S haematobium Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage ANTHELMINTICS (CONT’D) ANTHELMINTICS Parasitic Infections(9of14) Dosage Guidelines B9 • • Instructions Special • • Reactions Adverse • Instructions Special • Reactions Adverse • Instructions Special • • Reactions Adverse drug should not drive oroperate machinery shouldnotdrive drug patients takingthe May drowsiness; cause ofthe parasite destruction from damage resulting eye ofsevere ofrisk because inpatients cysticercosis notuse w/ocular Do eosinophilia) skin rashes, (fever, reactions Hypersensitivity urticaria, malaise headache, dizziness, discomfort); abdominal (N/V,GI symptoms pain, abdominal hepatic &renal impairmentconditions, Use w/caution inpatients w/CNS bronchospasm) rashes, Other effabnormalities), skin (urticaria, ects EEG confusion, paresthesia, ataxia, eff CNS diarrhea), nystagmus, (headache, ects GI eff (N/V,ects pain,colic, abdominal activity chemicals w/anticholinesterase orother agricultural toinsecticides exposed Avoid administration inpatients recently activity eff ofcholinesterase duetodepression ects cholinergic severe produces Occasionally weakness dizziness, pain); headache, (N/V,GI symptoms abdominal diarrhea, Remarks © MIMS 2019 PARASITIC INFECTIONS 1 Combination w/ Oxantel is available. Please see the forspecifi latest MIMS Combination see w/Oxantel isavailable. Please c formulations. Levamisole Tetramisole Levo-isomer HCl Oxamniquine Tetrahydroquinoline embonate pamoate, Pyrantel (Pyrantel Pyrantel Tetrahydropyrimidine Derivative Niclosamide Derivative Acid Salicylic Drug 1 ) Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All dose asingle as 2.5mg/kgPO infection 1wkinsevere after dose repeat asingledose; as 120-150 mgPO &Hookworm: Ascaris Mixed asingledose as 120-150 mgPO Ascariasis: 2-3days over given 60 mg/kgPO to asingledose as 15 mg/kg/day PO : S mansoni 24hrly x2days 20 mg/kgPO 24hrly x3-4days, 10 mg/kgPO Hookworms: 1g dose: Max in 2wk repeat singledose; as 10 mg/kgPO Enterobiasis: dose POasasingle mg/kg 5 Ascariasis: © MIMS asingledose as 2 gPO ): D caninum &Dlatum Tsolium, Tapeworms (Tsaginata, Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage Parasitic Infections(10of14) ANTHELMINTICS (CONT’D) ANTHELMINTICS Dosage Guidelines B10 • • Instructions Special • Reactions Adverse • • • Instructions Special • • Reactions Adverse • Instructions Special • • Reactions Adverse • Instructions Special • Reactions Adverse Sjogren’s syndrome w/ diagnosed Fluorouracil orwhohave been Use w/ caution inpatients receiving disorders Avoid inpatients blood use w/preexisting dizziness, headache GI symptoms(N/V,diarrhea,abdominalpain); oroperate machinery shouldnotdrive drug patients takingthe May drowsiness; cause in pregnancy Contraindicated inpatients notuse disorders w/seizure Do changes (ECG) electrocardiography electroencephalography & (EEG) GI eff liver enzymes); elevated (diarrhea, ects discolorationorange tored ofurine fever, headache, drowsiness, rash, Dizziness, impairment Use w/caution inpatients w/hepatic skin rashes insomnia, drowsiness, dizziness, Headache, liver enzymes) elevated diarrhea, GI eff (N/V,ects pain, abdominal anorexia, washed down w/water down washed Tablets thoroughly & chewed shouldbe rash rarely lightheadedness, Mild GIsymptoms, Remarks © MIMS 2019 PARASITIC INFECTIONS Etofamide furoate) (Diloxanide Diloxanide Derivatives Paromomycin Chloroquine 4-Aminoquinoline Drug Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All

© MIMS 12hrly x3days 500 mgPO passer): cyst (asymptomatic E histolytica 8hrly x10days 500 mgPO passer): cyst (asymptomatic E histolytica 3g/day dose: Max 7 days x hrly POdivided8 mg/kg/day 25-35 Giardiasis: 8hrly divided 1.5-2.25 g/day PO Cryptosporidiosis: 7-10 days x hrly POdivided8 mg/kg/day 25-35 disease: intestinal Amoebic or w/ given then x2or3wk, 300mg/day PO x2days, 600 mg/day PO abscess): or liver (severe disease intestinal Amoebic Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage Parasitic Infections(11of14) Dosage Guidelines ANTIAMOEBICS B11 • Reactions Adverse • Instructions Special • • Reactions Adverse • Instructions Special • • Reactions Adverse Flatulence, vomiting organisms ofnonsusceptible ofovergrowth risk ulcerative lesions, bowel impaired hearing, impairment, neuromuscular disorders or Use w/caution inpatients w/renal orhepatic fever,drug anaphylaxis) &diarrhea); steatorrhea w/severe syndrome therapy may produce malabsorption (N/V,GI symptoms oral prolonged diarrhea, &arrest depression actionw/resp blocking Ototoxicity, nephrotoxicity, neuromuscular defi ciency G6PD myasthenia, disorders, neurologic GI& ofsevere history impairment, psoriasis, Use w/caution inpatients w/renal orhepatic Visual keratopathy, disturbances, retinopathy pruritus eruptions, (N/V,GI symptoms skin headache, diarrhea); Hypersensitivity reactions (rashes, pruritus, pruritus, (rashes, reactions Hypersensitivity Remarks © MIMS 2019 PARASITIC INFECTIONS Tinidazole Secnidazole Ornidazole Nimorazole Metronidazole Derivatives Nitroimidazole Drug Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All

©dose asingle as 2gPO Giardiasis: 24hrly x3-6days 1.5-2 gPO abscess): orliver (severe disease intestinal Amoebic MIMS 24hrly x3days 2 gPO (mild-moderate): disease intestinal Amoebic dose asingle as 2gPO Giardiasis: 8hrly x5days 500 mgPO abscess): orliver (severe disease intestinal Amoebic asingledose as 2 gPO (mild-moderate): disease intestinal Amoebic 1-2 days 24hrly x 1-1.5gPO Giardiasis: 12hrly x5-10days 500 mgPO (mild-moderate): disease intestinal Amoebic 5-7 days 12hrly x 500mgPO Giardiasis: 12hrly x5-10days 1g PO (mild-moderate): disease intestinal Amoebic 8hrly x7days 500 mgIV 8hrly0.75-1g/day x5days PO 24hrly x3days 2 gPO Giardiasis: 8hrly 500 mgIV abscess): orliver (severe disease intestinal Amoebic 8hrly x7days 500-750 mgPO (mild-moderate): disease intestinal Amoebic Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage Parasitic Infections(12of14) ANTIAMOEBICS (CONT’D) ANTIAMOEBICS Dosage Guidelines B12 • • • Instructions Special • • • Reactions Adverse CBCs & clinical monitoring for CNS eff forCNS monitoring &clinical CBCs ects recommend monitoring >10days, If given impairment Use hepatic w/caution inpatients w/severe occur can reaction When w/alcohol, given aDisulfiram-like neuropathy seizures peripheral &epileptiform caused has use orprolonged High dose infection) reactions; Rarely hypersensitivity occurred; &hepaticHematologic eff doses); have ects neuropathy at high/prolonged occurred has peripheral changes; mood headache, dizziness, effCNS (weakness, reported have been ects constipation) GI eff (N/V,ects diarrhea, taste, metallic May cause darkening of ; Other (Candidal (Candidal Other darkening May cause ofurine; Remarks © MIMS 2019 PARASITIC INFECTIONS Erythromycin (Iodoquinol) Oxyquinoline Drug Drug Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All © MIMS Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing 12 hrly 6 hrly or 500 mgPO disease: intestinal Amoebic 2g/day dose: Max 8hrly x20days 650 mgPO passer): cyst (asymptomatic E histolytica 250-400 mg PO 250-400mgPO Parasitic Infections(13of14) Dosage Dosage ANTIAMOEBICS (CONT’D) ANTIAMOEBICS Dosage Guidelines MACROLIDE B13 • • Instructions Special • • Reactions Adverse • • • Instructions Special • • Reactions Adverse & renal function Use w/ caution inpatients w/impaired hepatic distress gastric todecrease May takew/food loss tinnitus/hearing Dose-related hepatotoxicity; Rarely conduction, cardiac altered rarely rash, anaphylaxis); pruritus, (urticaria, are reactions uncommon Hypersensitivity eff vertigo) (candidal infections, ects diarrhea/colitis); Other -associated &other diarrhea GIdisturbances, GI eff (N/V,ects discomfort, abdominal w/meals tolerated ifgiven Best completion oftherapy formonths thyroid tests after function contentHigh iodine interfere of can w/results renal impairment hydroxyquinolines w/hepatic or &inthose orhalogenated toiodine hypersensitivity in patientsContraindicated w/known administration at highdoses neuropathyperipheral may occur w/prolonged damage orinfl nerve Optic ammation & the thyroidNeurotoxicity gland); enlargement ani,skineruptions, of (pruritus Eff diarrhea); content related toiodine ects nausea, cramps, (abdominal GI symptoms Remarks Remarks © MIMS 2019 PARASITIC INFECTIONS Nitazoxanide Other Furazolidone Derivative Mepacrine (Quinacrine) Mepacrine 9-Aminoacridine Drug Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All © MIMS Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing immunodefi cient) 14 days (if 12hrly x 500 mgPO 12hrly x3days 500 mgPO Cryptosporidiosis: 12hrly x3days 500 mgPO &Giardiasis: Ascariasis 7-10 days 6hrly x 100 mgPO Giardiasis: 8 hrly x5-7 days 100mgPO Giardiasis: Please see the end of this section for the reference list. reference the for section this of end the see Please OTHER ANTIPROTOZOALAGENTS Parasitic Infections(14of14) Dosage Dosage Guidelines B14 • Precautions: Special • EffAdverse ects: • Instructions Special • Reactions Adverse • • Instructions Special • • Reactions Adverse Take w/food the drug vomiting); headache GI symptoms(abdominalpain,diarrhea, Use w/caution inpatients w/G6PDdeficiency darkening ofthe urine allergic skinreactions, malaise, headache, N/V, drowsiness, dizziness, Avoid inpatients use w/psoriasis ofpsychosis hepatic impairment orhistory Use w/caution inelderly patients w/ patients, toxicity,Ocular at highdoses seizures discoloration ofpalate &nails Blue/black urine; of skin,conjunctiva, yellowadministration, discoloration reversible (N/V, other long GIdisturbances);During effCNS GIeff headache); (dizziness, ects ects Remarks © MIMS 2019

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