Page 1 of 2 BALANTIDIASIS (Balantidium coli) Drug Adult dosage Pediatric dosage Drug of choice: Tetracycline1,2 500 mg PO qid x 10d 40 mg/kg/d (max. 2 g) PO in 4 doses x 10d Alternative: Metronidazole1 750 mg PO tid x 5d 35-50 mg/kg/d PO in 3 doses x 5d OR Iodoquinol1,3 650 mg PO tid x 20d 30-40 mg/kg/d (max 2 g) PO in 3 doses x 20d 1. Not FDA-approved for this indication. 2. Use of tetracyclines is contraindicated in pregnancy and in children <8 years old. Tetracycline should be taken 1 hour before or 2 hours after meals and/or dairy products. 3. Iodoquinol should be taken after meals.

Information provided by The Medical Letter. For a copy of the entire Drugs for Parasitic Infections article, go to: www.medicalletter.org/parasitic_cdc

MANUFACTURERS OF DRUGS USED TO TREAT PARASITIC INFECTIONS albendazole – Albenza (GlaxoSmithKline) lumefantrine/artemether – Coartem, Riamet Albenza (GlaxoSmithKline) – albendazole (Novartis) Alinia (Romark) – nitazoxanide Malarone (GlaxoSmithKline) – AmBisome (Gilead) – amphotericin B, liposomal atovaquone/proguanil amphotericin B – Fungizone (Apothecon), others malathion – Ovide (Medicis) amphotericin B, liposomal – AmBisome (Gilead) mebendazole – Vermox (McNeil), others Ancobon (Valeant) – flucytosine mefloquine – Lariam (Roche) § Antiminth (Pfizer) – pyrantel pamoate § meglumine antimonate – Glucantime (Aventis, • Aralen (Sanofi) – chloroquine HCl and chloroquine France) phosphate † melarsoprol – Mel-B § artemether – Artenam (Arenco, Belgium) † Mel-B – melarsoprol § artemether/lumefantrine – Coartem, Riamet Mepron (GlaxoSmithKline) – atovaquone (Novartis) metronidazole – Flagyl (Pfizer), others § Artenam (Arenco, Belgium) – artemether § miconazole – Monistat i.v. § artesunate – (Guilin No. 1 Factory, People’s § miltefosine – Impavido (Zentaris, Germany) Republic of China) § Monistat i.v. – miconazole atovaquone – Mepron (GlaxoSmithKline) NebuPent (Fujisawa) – pentamidine isethionate atovaquone/proguanil – Malarone § niclosamide – Yomesan (Bayer, Germany) (GlaxoSmithKline) † nifurtimox – Lampit (Bayer, Germany) azithromycin – Zithromax (Pfizer), others nitazoxanide – Alinia (Romark) • Bactrim (Roche) – TMP/Sulfa Nix (GlaxoSmithKline) – permethrin § benznidazole – Rochagan (Brazil) • Nizoral (Janssen) – ketoconazole • Biaxin (Abbott) – clarithromycin § ornidazole – Tiberal (Roche, France) § Biltricide (Bayer) – praziquantel Ornidyl (Aventis) – eflornithine † bithionol – Bitin (Tanabe, Japan) (Difluoromethylornithine, DFMO) † Bitin (Tanabe, Japan) – bithionol Ovide (Medicis) – malathion § Brolene (Aventis, Canada) – propamidine § oxamniquine – Vansil (Pfizer) isethionate § Paludrine (AstraZeneca, United Kingdom) – proguanil chloroquine HCl and chloroquine phosphate – paromomycin – Humatin (Monarch); Leshcutan Aralen (Sanofi), others (Teva, Israel; topical formulation not available clarithromycin – Biaxin (Abbott), others in US) • Cleocin (Pfizer) – clindamycin Pentam 300 (Fujisawa) – pentamidine isethionate clindamycin – Cleocin (Pfizer), others pentamidine isethionate – Pentam 300 (Fujisawa), Coartem (Novartis) – artemether/lumefantrine NebuPent (Fujisawa) crotamiton – Eurax (Westwood-Squibb) † Pentostam (GlaxoSmithKline, United Kingdom) – dapsone – (Jacobus) sodium stibogluconate § Daraprim (GlaxoSmithKline) – pyrimethamine USP permethrin – Nix (GlaxoSmithKline), Elimite † diethylcarbamazine citrate (DEC) – Hetrazan (Allergan) • Difluca\n (Pfizer) – fluconazole § praziquantel – Biltricide (Bayer) § diloxanide furoate – Furamide (Boots, United primaquine phosphate USP Kingdom) § proguanil – Paludrine (AstraZeneca, United Kingdom) doxycycline – Vibramycin (Pfizer), others proguanil/atovaquone – Malarone eflornithine (Difluoromethylornithine, DFMO) – (GlaxoSmithKline) Ornidyl (Aventis) § propamidine isethionate – Brolene (Aventis, § Egaten (Novartis) – triclabendazole Canada) Elimite (Allergan) – permethrin § pyrantel pamoate – Antiminth (Pfizer) Ergamisol (Janssen) – levamisole pyrethrins and piperonyl butoxide – RID (Pfizer), Eurax (Westwood-Squibb) – crotamiton others • Flagyl (Pfizer) – metronidazole § pyrimethamine USP – Daraprim (GlaxoSmithKline) § Flisint (Sanofi-Aventis, France) – fumagillin Qualaquin – quinine sulfate (Mutual Pharmaceutical fluconazole – Diflucan (Pfizer), others Co/AR Scientific) flucytosine – Ancobon (Valeant) quinacrine § fumagillin – Flisint (Sanofi-Aventis, France) * quinidine gluconate (Eli Lilly) • Fungizone (Apothecon) – amphotericin § quinine dihydrochloride § Furamide (Boots, United Kingdom) – diloxanide quinine sulfate – Qualaquin (Mutual Pharmaceutical furoate Co/AR Scientific) § furazolidone – Furozone (Roberts) Riamet (Novartis) – artemether/lumefantrine § Furozone (Roberts) – furazolidone • RID (Pfizer) – pyrethrins and piperonyl butoxide † Germanin (Bayer, Germany) – suramin sodium • Rifadin (Aventis) – rifampin § Glucantime (Aventis, France) – meglumine rifampin – Rifadin (Aventis), others antimonate § Rochagan (Brazil) – benznidazole † Hetrazan – diethylcarbamazine citrate (DEC) * Rovamycine (Aventis) – spiramycin Humatin (Monarch) – paromomycin † sodium stibogluconate – Pentostam § Impavido (Zentaris, Germany) – miltefosine (GlaxoSmithKline, United Kingdom) iodoquinol – Yodoxin (Glenwood), others * spiramycin – Rovamycine (Aventis) itraconazole – Sporanox (Janssen-Ortho), others • Sporanox (Janssen-Ortho) – itraconazole ivermectin – Stromectol (Merck) Stromectol (Merck) – ivermectin ketoconazole – Nizoral (Janssen), others sulfadiazine – (Eon) † Lampit (Bayer, Germany) – nifurtimox † suramin sodium – Germanin (Bayer, Germany) Lariam (Roche) – mefloquine § Tiberal (Roche, France) – ornidazole § Leshcutan (Teva, Israel) – topical paromomycin Tindamax (Mission) – tinidazole levamisole – Ergamisol (Janssen) tinidazole – Tindamax (Mission) (continued) Page 2 of 2 TMP/Sulfa – Bactrim (Roche), others • Vibramycin (Pfizer) – doxycycline § triclabendazole – Egaten (Novartis) • Yodoxin (Glenwood) – iodoquinol § Vansil (Pfizer) – oxamniquine § Yomesan (Bayer, Germany) – niclosamide • Vermox (McNeil) – mebendazole • Zithromax (Pfizer) – azithromycin

* Available in the US only from the manufacturer. § Not available commercially. It may be obtained through compounding pharmacies such as Panorama Compounding Pharmacy, 6744 Balboa Blvd, Van Nuys, CA 91406 (800-247-9767) or Medical Center Pharmacy, New Haven, CT (203-688-6816). Other com- pounding pharmacies may be found through the National Association of Compounding Pharmacies (800-687-7850) or the Professional Compounding Centers of America (800-331-2498, www.pccarx.com). † Available from the CDC Drug Service, Centers for Disease Control and Prevention, Atlanta, Georgia 30333; 404-639-3670 (evenings, weekends, or holidays: 770-488-7100). • Also available generically.

Information provided by The Medical Letter. For a copy of the entire Drugs for Parasitic Infections article, go to: www.medicalletter.org/parasitic_cdc