A Textbook of Clinical Pharmacology and Therapeutics

HELMINTHICINFECTION 365

Table 47.2:Drug therapy of non-malarial protozoan infections

Protozoan species Drug therapy Additional comments

Trichomonas vaginalis Metronidazole or tinidazole The most common protozoan infection. Treat the

patient and their sexual partner

T. cruzi(American) Benznidazole or nifurtimox Effective in the early acute stages

T. gambienseand Pentamidine and suramin are Later neurological disease – melarsoprol or

T. rhodesiense(African) effective in the early stages eflornithine or nifurtimox

Toxoplasma gondii Pyrimethamine/sulfadiazine Add folinic acid to reduce risk of bone marrow

suppression

Pneumocystis carinii Sulfamethoxazole/trimethoprim – high dose Alternatives: pentamidine, atovaquone, see

Chapter 46

Leishmania (visceral) Sodium stibogluconate or meglumine Resistant cases – add allopurinol plus pentamidine

antimoniate with or without amphotericin B

Leishmania (cutaneous) Intralesional – antimonials Lesions usually heal spontaneously

Giardia lamblia Metronidazole or tinidazole Treat family and institutional contacts

Table 47.3:Drug therapy for common helminthic infections

Helminthic species Drug therapy Comment

Tapeworms

Taenia saginata Praziquantel or niclosamide or gastrograffin A single dose of praziquantel is curative

Cysticercosis

Taenia solium Praziquantel or gastrograffin

Diphyllobothrium latum Praziquantel or niclosamide or gastrograffin

Hydatid disease

Echinococcus granulosus Albendazole or mebendazole Surgery for operably treatable cysts

Hookworm

Ancylostoma duodenale Mebendazole/albendazole, bephenium or

pyrantel pamoate

Necator americanus

Strongyloides stercoralis Albendazole

Threadworm

Enterobius vermicularis Mebendazole/albendazole, bephenium or

pyrantel pamoate

Whipworm

Trichuris trichiuria Thiabendazole

Tissue nematodes

Ancylostoma braziliensae Thiabendazole

Guinea worm

Dracunculus medinensis Metronidazole Symptoms quickly relieved

Visceral larvae/roundworms

Toxocara canis Diethylcarbamazine Progressively increasing dose, allergic

Toxocara catis reactions to dying larvae, glucocorticosteroids

required for ocular disease

(continued)