" MD Consult - Book Text AAP 1997 Red Book: Report of the Committee on Infectious Diseases, 24th ed., Copyright © 1997 American Academy of Pediatrics

P637

DRUGS FOR PARASITIC INFECTIONS

The following tables (5.8, 5.9, and 5.10) are reproduced from The Medical Letter (1995;37:99-108). * They provide recommendations that are likely to be consistent in many cases with those of the Committee on Infectious Diseases, as given in the chapters on specific diseases in Section 3 . However, because The Medical Letter recommendations are developed independently and were issued in 1995, these recommendations occasionally may differ from those of the Committee. Accordingly, both should be consulted. The Committee thanks The Medical Letter for their courtesy in allowing this information to be reprinted.

In Table 5.8 (p 638) , first-choice and alternative drugs with recommended adult and pediatric dosages for most parasitic infections are given. In each case, the need for treatment must be weighed against the toxic effects of the drug. A decision to withhold therapy often may be correct, particularly when the drugs can cause severe adverse effects. When the first-choice drug is initially ineffective and the alternative is more hazardous, a second course of treatment with the first drug before giving the alternative may be prudent. Adverse effects of some antiparasitic drugs are listed in Table 5.10 (p 661) .

Several drugs recommended in Table 5.8 have not been approved by the Food and Drug Administration and, thus, are investigational (see footnotes). When prescribing an unapproved drug, the physician should inform the patient of the investigational status and adverse effects of the drug.

These recommendations are periodically (usually every other year) updated by The Medical Letter and, thus, are likely to be superseded by new ones before the next edition of the Red Book is published.

* Reprinted with permission from The Medical Letter.
P638

TABLE 5-8 -- Drugs for Treatment of Parasitic Infections
Infection Drug Adult dosage * Pediatric dosage *
AMEBIASIS (Entamoeba histolytica) 1


    asymptomatic


    Drug of choice: Iodoquinol 2 650 mg tid × 20d 30-40 mg/kg/d in 3 doses × 20d
OR Paromomycin 25-35 mg/kg/d in 3 doses × 7d 25-35 mg/kg/d in 3 doses × 7d
    Alternative: Diloxanide furoate 3 500 mg tid × 10d 20 mg/kg/d in 3 doses × 10d
    mild to moderate intestinal disease


    Drug of choice 4 : Metronidazole 750 mg tid × 10d 35-50 mg/kd/d in 3 doses × 10d
OR Tinidazole 5 2 grams/d × 3d 50 mg/kg (max. 2 grams) qd × 3d
    severe intestinal disease, hepatic abscess


    Drug of choice 4 : Metronidazole 750 mg tid × 10d 35-50 mg/kd/d in 3 doses × 10d
OR Tinidazole 5 600 mg bid or 800 mg tid × 5d 50 mg/kg or 60 mg/kg (max. 2 grams) qd × 3d
AMEBIC (Acanthamoeba) keratitis


    Drug of choice: See 6

AMEBIC MENINGOENCEPHALITIS, PRIMARY
    Naegleria


    Drug of choice: Amphotericin B 7 8 1 mg/kg/d IV, uncertain duration 1 mg/kg/d IV, uncertain duration
    Acanthamoeba


    Drug of choice: See 9

ANCYLOSTOMA caninum (Eosinophilic enterocolitis)
    Drug of choice: Mebendazole 100 mg bid × 3d 100 mg bid × 3d
OR Pyrantel pamoate 8 11 mg/kg (max. 1 gram) × 3d 11 mg/kg (max. 1 gram) × 3d
OR Albendazole 400 mg once 400 mg once
Ancylostoma duodenale, see HOOKWORM
ANGIOSTRONGYLIASIS


    Angiostrongylus cantonensis


    Drug of choice 1 : Mebendazole 8 100 mg bid × 5d 100 mg bid × 5d
    Angiostrongylus costaricensis


    Drug of choice: Thiabendazole 8 75 mg/kg/d in 3 doses × 3d (max. 3 grams/d) 1 75 mg/kg/d in 3 doses × 3d (max. 3 grams/d) 1
    Alternative: Mebendazole 200-400 mg tid × 10d 200-400 mg tid × 10d
ANISAKIASIS (Anisakis)


    Treatment of choice: Surgical or endoscopic removal

ASCARIASIS (Ascaris lumbricoides, roundworm)
    Drug of choice: Mebendazole 100 mg bid × 3d 100 mg bid × 3d
OR Pyrantel pamoate 11 mg/kg once (max. 1 gram) 11 mg/kg once (max. 1 gram)
OR Albendazole 400 mg once 400 mg once
BABESIOSIS (Babesia spp.)


    Drugs of choice 1 : Clindamycin 8 1.2 grams bid IV or 500 mg tid PO × 7d 20-40 mg/kg/d in 3 doses × 7d

plus quinine 650 mg tid PO × 7d 25 mg/kg/d in 3 doses × 7d
BALANTIDIASIS (Balantidium coli)


    Drug of choice: Tetracyclin 8 500 mg qid × 10d 40 mg/kg/d in 4 doses × 10d (max. 2 grams/d) 1
    Alternatives: Iodoquinol 2 8 650 mg tid × 20d 40 mg/kg/d in 3 doses × 20d

Metronidazole 8 750 mg tid × 5d 35-50 mg/kg/d in 3 doses × 5d
BAYLISASCARIASIS (Baylisascaris procyonis)
    Drug of choice: See 1

BLASTOCYSTIS hominis infection


    Drug of choice: See 1

CAPILLARIASIS (Capillaria philippinensis)
    Drug of choice: Mebendazole 8 200 mg bid × 20d 200 mg bid × 20d
    Alternatives: Albendazole 200 mg bid × 10d 200 mg bid × 10d

Thiabendazole 8 25 mg/kg/d in 2 doses × 30d 25 mg/kg/d in 2 doses × 30d
Chagas disease, see TRYPANOSOMIASIS


Clonorchis sinensis, see FLUKE infection


CRYPTOSPORIDIOSIS (Cryptosporidium)
    Drug of choice 1 : Paromomycin 500-750 mg qid
CUTANEOUS LARVA MIGRANS (creeping eruption, dog and cat hookworm)
    Drug of choice 1 : Thiabendazole Topically ± 50 mg/kg/d PO in 2 doses (max. 3 grams/d) × 2-5d 1 Topically ± 50 mg/kg/d PO in 2 doses (max. 3 grams/d) × 2-5 1
OR Ivermectin 150-200 µg/kg once 150-200 µg/kg once
OR Albendazole 200 mg bid × 3d 200 mg bid × 3d
CYCLOSPORA infection


    Drug of choice: Trimethoprim-sulfamethoxazole 1 TMP 160 mg, SMX 800 mg bid × 7 days TMP 5 mg/kg, SMX 25 mg/kg bid × 7 days
CYSTICERCOSIS, see TAPEWORM infection
DIENTAMOEBA fragilis infection


    Drug of choice: Iodoquinol 2 650 mg tid × 20d 40 mg/kg/d in 3 doses × 20d
OR Paromomycin 25-30 mg/kg/d in 3 doses × 7d 25-30 mg/kg/d in 3 doses × 7d
OR Tetracycline 8 500 mg qid × 10d 40 mg/kg/d (max. 2 grams/d) in 4 doses × 10d 1
Diphyliobothrium latum, see TAPEWORM infection
DRACUNCULUS medinensis (guinea worm) infection
    Drug of choice: Metronidazole 8 1 250 mg tid × 10d 25 mg/kg/d (max. 750 mg/d) in 3 doses × 10d
    Alternative: Thiabendazole 8 1 50-75 mg/kg/d in 2 doses × 3d 1
Echinococcus, see TAPEWORM infection


Entamoeba histolytica, see AMEBIASIS


ENTAMOEBA polecki infection


    Drug of choice: Metronidazole 8 750 mg tid × 10d 35-50 mg/kg/d in 3 doses × 10d
ENTEROBIUS vermicularis (pinworm) infection
    Drug of choice: Pyrantel pamoate 11 mg/kg once (max. 1 gram); repeat after 2 weeks 11 mg/kg once (max. 1 gram); repeat after 2 weeks
OR Mebendazole A single dose of 100 mg; repeat after 2 weeks A single dose of 100 mg; repeat after 2 weeks
OR Albendazole 400 mg once; repeat in 2 weeks 400 mg once; repeat in 2 weeks
Fasciola hepatica, see FLUKE infection


FILARIASIS


    Wuchereria bancrofti, Brugia malayi


    Drug of choice 2 : Diethylcarbamazine 2 Day 1: 50 mg, p.c. Day 1: 1 mg, p.c.


Day 2: 50 mg tid Day 2: 1 mg tid


Day 3: 100 mg tid Day 3: 1-2 mg tid


Days 4 through 21: 6 mg/kg/d in 3 doses 2 Days 4 through 21: 6 mg/kg/d in 3 doses 2
Loa loa


Drug of choice 2 : Diethylcarbamazine 2 Day 1: 50 mg, oral, p.c. Day 1: 1 mg, oral, p.c.


Day 2: 50 mg tid Day 2: 1 mg tid


Day 3: 100 mg tid Day 3: 1-2 mg tid


Days 4 through 21: 9 mg/kg/d in 3 doses 2 Days 4 through 21: 9 mg/kg/d in 3 doses 2
Mansonella ozzardi


Drug of choice: See 2

Mansonella perstans


Drug of choice: Mebendazole 8 100 mg bid × 30d
Tropical Pulmonary Eosinophilia (TPE)
Drug of choice: Diethylcarbamazine 6 mg/kg/d in 3 doses × 21d 6 mg/kg/d in 3 doses × 21d
Onchocerca volvulus


Drug of choice: Ivermectin 3 150 µ/kg once, repeated every 3 to 12 months 150 µg/kg once, repeated every 3 to 12 months
FLUKE, hermaphroditic, infection


    Clonorchis sinensis (Chinese liver fluke


    Drug of choice: Praziquantel 75 mg/kg/d in 3 doses × 1d 75 mg/kg/d in 3 doses × 1d
OR Albendazole 10 mg/kg × 7d
    Fasciola hepatica (sheep liver fluke)


    Drug of choice 2 : Bithionol 3 30-50 mg/kg on alternate days × 10-15 doses 30-50 mg/kg on alternate days × 10-15 doses
    Fasciolopsis buski (intestinal fluke)


    Drug of choice: Praziquantel 8 75 mg/kg/d in 3 doses × 1d 75 mg/kg/d in 3 doses × 1d
    Heterophyes heterophyes (intestinal fluke)


    Drug of choice: Praziquantel 8 75 mg/kg/d in 3 doses × 1d 75 mg/kg/d in 3 doses × 1d
    Metagonimus yokogawai (intestinal fluke)


    Drug of choice: Praziquantel 8 75 mg/kg/d in 3 doses × 1d 75 mg/kg/d in 3 doses × 1d
    Nanophyetus salmincola


    Drug of choice: Praziquantel 8 60 mg/kg/d in 3 doses × 1d 60 mg/kg/d in 3 doses × 1d
    Opisthorchis viverrini (liver fluke)


    Drug of choice: Praziquantel 75 mg/kg/d in 3 doses × 1d 75 mg/kg/d in 3 doses × 1d
    Paragonimus westermani (lung fluke)


    Drug of choice: Praziquantel 8 75 mg/kg/d in 3 doses × 2d 75 mg/kg/d in 3 doses × 2d
    Alternative 2 : Bithionol 3 30-50 mg/kg on alternate days × 10-15 doses 30-50 mg/kg on alternate days × 10-15 doses
GIARDIASIS (Giardia lamblia)


    Drug of choice: Metronidazole 8 250 mg tid × 5d 15 mg/kg/d in 3 doses × 5d
    Alternatives 2 : Tinidazole 5 2 grams once 50 mg/kg once (max. 2 gram)

Furazolidone 100 mg qid × 7-10d 6 mg/kg/d in 4 doses × 7-10d

Paromomycin 2 25-35 mg/kg/d in 3 doses × 7d
GNATHOSTOMIASIS (Gnathostoma spinigerum)
    Treatment of choice 2 : Surgical removal


plus


Albendazole 3 400-800 mg qd × 21d
HOOKWORM infection (Ancylostoma duodenale, Necator americanus)
    Drug of choice: Mebendazole 100 mg bid × 3d 100 mg bid ×3d
OR Pyrantel pamoate 8 11 mg/kg (max. 1 gram) × 3d 11 mg/kg (max. 1 gram) × 3d
OR Albendazole 400 mg once 400 mg once
Hydatid cyst, see TAPEWORM infection


Hymenolepis nana, see TAPEWORM infection
ISOSPORIASIS (Isospora belli)


    Drug of choice: Trimethoprim-sulfamethoxazole 8 3 160 mg TMP, 800 mg SMX qid × 10d, then bid × 3 wks
LEISHMANIASIS (L. mexicana, L. tropica, L. major, L. braziliensis, L. donovani (Kala-azar))
    Drug of choice: Sodium stibogluconate 3 20 mg Sb/kg/d IV or IM × 20-28d 3 20 mg Sb/kg/d IV or IM × 20-28d 3
OR Meglumine antimonate 20 mg Sb/kg/d × 20-28d 3 20 mg Sb/kg/d × 20-28d 3
    Alternatives 3 : Amphotericin B 8 0.25 to 1 mg/kg by slow infusion daily or every 2d for up to 8 wks 0.25 to 1 mg/kg by slow infusion daily or every 2d for up to 8 wks

Pentamidine isethionate 8 2-4 mg/kg daily or every 2d IM for up to 15 doses 3 2-4 mg/kg daily or every 2 d IM for up to 15 doses 3
LICE infestation (Pediculus humanus, capitis, Phthirus pubis) 3
    Drug of choice: 1% Permethrin 3 Topically Topically

0.5% Malathion Topically Topically
OR


    Alternative: Pyrethrins with piperonyl butoxide Topically 3 Topically 3
Loa loa, see FILARIASIS


MALARIA, Treatment of (Plasmodium falciparum, P. ovale, P. vivax, and P. malariae)
Chloroquine-resistant P. falciparum 3


    ORAL


    Drugs of choice: Quinine sulfate 650 mg q8h × 3-7d 3 25 mg/kg/d in 3 doses × 3-7d 3

plus


pyrimethamine-sulfaxodoxine 3 3 tablets at once on last day of quinine <1 yr: 1/4 tablet

1-3 yrs: 1/2 tablet



4-8 yrs: 1 tablet



9-14 yrs: 2 tablets

plus tetracycline 8 250 mg qid × 7d 20 mg/kg/d in 4 doses × 7d 1

OR


plus clindamycin 8 900 mg tid × 3-5d 20-40 mg/kg/d in 3 doses × 3-5d
OR 4


Alternatives: 4 Mefloquine 4 4 1250 mg 4 25 mg/kg once 4 (<45 kg)

Halofantrine 4 500 mg q6h × 3 doses; repeat in 1 week 8 mg/kg q6h × 3 doses (<40 kg); repeat in 1 week
    PARENTERAL


    Drug of choice 4 4 : Quinidine gluconate 4 5 10 mg/kg loading dose (max. 600 mg) in normal saline slowly over 1 to 2 hrs, followed by continuous infusion of 0.02 mg/kg/min until oral therapy can be started Same as adult dose
OR Quinine dihydrochloride 5 5 20 mg/kg loading dose in 10 mg/kg 5% dextrose over 4 hrs, followed by 10 mg/kg over 2-4 hrs q8h (max: 1800 mg/d) until oral therapy can be started Same as adult dose
All Plasmodium except Chloroquine-resistant P. falciparum 3
    ORAL


    Drug of choice: Chloroquine phosphate 5 5 1 gram (600 mg base), then 500 mg (300 mg base) 6 hrs later, then 500 mg (300 mg base) at 24 and 48 hrs 10 mg base/kg (max. 600 mg base), then 5 mg base/kg 6 hrs later, then 5 mg base/kg at 24 and 48 hrs
    PARENTERAL


    Drug of choice 4 : Quinidine gluconate 4 5 same as above same as above
OR Quinine dihydrochloride 5 5 same as above same as above
Prevention of relapses: P. vivax and P. ovale only
    Drug of choice: Primaquine phosphate 5 5 26.3 mg (15 mg base)/d × 14d or 79 mg (45 mg base)/wk × 8 wks 0.3 mg base/kg/d × 14d
MALARIA, Prevention of Chloroquine-sensitive areas


        Drug of choice: Chloroquine phosphate 5 500 mg (300 mg base), once/week 5 5 mg/kg base once/week, up to adult dose of 300 mg base
    Chloroquine-resistant areas 3


        Drug of choice: Mefloquine 5 5 6 250 mg once/week 5 15-19 kg: 1/4 tablet



20-30 kg: 1/2 tablet



31-45 kg: 3/4 tablet



>45 kg: 1 tablet

Doxycycline 5 6 100 mg daily 6 >8 years of age: 2 mg/kg/d, up to 100 mg/day
OR


        Alternatives: Chloroquine phosphate 5 same as above same as above

plus


Pyrimethamine-sulfadoxine 3 for presumptive treatment Carry a single dose (3 tablets) for self-treatment of febrile illness when medical care is not immediately available <1 yr: 1/4 tablet

1-3 yrs: 1/2 tablet

4-8 yrs: 1 tablet

9-14 yrs: 2 tablets

or plus proguanil 6 (in Africa south of the Sahara) 200 mg daily <2 yrs: 50 mg daily


2-6 yrs: 100 mg daily


7-10 yrs: 150 mg daily



>10 yrs: 200 mg daily
MICROSPORIDIOSIS


    Ocular (Encephalitozoon hellem, Vittaforma corneae (Nosema corneum))
    Drug of choice: See 6

    Intestinal (Enterocytozoon bieneusi, Septata (Encephalitozoon) intestinalis)
    Drug of choice: See 6

    Disseminated (Encephalitozoon hellem, Encephalitozoon cuniculi, Pleistophora sp.)
    Drug of choice: See 6

Mites, see SCABIES


MONILIFORMIS moniliformis infection


    Drug of choice: Pyrantel pamoate 8 11 mg/kg once, repeat twice 2 wks apart 11 mg/kg once, repeat twice, 2 wks apart
Naegleria species, see AMEBIC MENINGOENCEPHALITIS, PRIMARY
Necator americanus, see HOOKWORM infection
OESOPHAGOSTOMUM bifurcum


    Drug of choice: See 6

Onchocerca volvulus, see FILARIASIS


Opisthorchis viverrini, see FLUKE infection
Paragonimus westermani, see FLUKE infection
Pediculus capitis, humanus, Phthirus pubis, see LICE
Pinworm, see ENTEROBIUS


PNEUMOCYSTIS carinii pneumonia 6


    Drug of choice: Trimethoprim-sulfamethoxazole TMP 15 mg/kg/d, SMX 75 mg/kg/d, oral or IV in 3 or 4 doses × 14-21d 6 Same as adult dose
    Alternatives 7 : Pentamidine Trimetrexate 3-4 mg/kg IV qd × 14-21 days 6 Same as adult dose

    plus folinic acid 45 mg/m2 IV qd × 21 days

Trimethoprim 8 20 mg/m2 PO or IV q6h × 21 days

    plus dapsone 8 5 mg/kg PO tid × 21 days

Atovaquone suspension 100 mg PO qd × 21 days

Primaquine 8 5 plus 750 mg bid PO × 21 d

    clindamycin 8 600 mg IV q6h × 21 days, or 300-450 mg PO q6h × 21 days
Primary and secondary prophylaxis


    Drug of choice: Trimethoprim-sulfamethoxazole 1 DS tab PO qc or 3×/week TMP 150 mg, SMX 750 mg in 2 doses PO 3×/week
    Alternatives: Dapsone 8 50-100 mg PO qd, or 100 mg PO 2×/week 2 mg/kg PO qd

±Pyrimethamine 7 50 mg PO 2×/week

Aerosol pentamidine 300 mg inhaled monthly via Respirgard II nebulizer >5 yrs: same as adult dose
Roundworm, see ASCARIASIS


SCABIES (Sarcoptes scabiei)


    Drug of choice: 5% Permethrin Topically Topically
    Alternatives: Ivermectin 200 µg/kg PO once 200 µg/kg PO once

10% Crotamiton Topically Topically
SCHISTOSOMIASIS (Bilharziasis)


    S. haematobium


    Drug of choice: Praziquantel 40 mg/kg/d in 2 doses × 1d 40 mg/kg/d in 2 doses × 1d
    S. japonicum


    Drug of choice: Praziquantel 50 mg/kg/d in 3 doses × 1d 50 mg/kg/d in 3 doses × 1d
    S. mansoni


    Drug of choice: Praziquantel 40 mg/kg/d in 2 doses × 1d 40 mg/kg/d in 2 doses × 1d

Oxamniquine 7 15 mg/kg once 7 20 mg/kg once 7
    S. mekongi


    Drug of choice: Praziquantel 60 mg/kg/d in 3 doses × 1d 60 mg/kg/d in 3 doses × 1d
Sleeping sickness, see TRYPANOSOMIASIS
STRONGYLOIDIASIS (Strongyloides stercoralis)
    Drug of choice: 7 Thiabendazole 50 mg/kg/d in 2 doses (max. 3 grams/d) × 2d 1 7 50 mg/kg/d in 2 doses (max. 3 grams/d) × 2d 1 7
OR Ivermectin 7 200 µg/kg/d × 1-2d 200 µg/kg/d × 1-2d
TAPEWORM infection--Adult (intestinal stage)
    Diphyllobothrium latum (fish), Taenia saginata (beef), Dipylidium caninum (dog)
    Drug of choice: Praziquantel 8 5-10 mg/kg once 5-10 mg/kg once
    Hymenolepis nana (dwarf tapeworm)


    Drug of choice: Praziquantel 8 25 mg/kg once 25 mg/kg once
            --Larval (tissue stage)


    Echinococcus granulosus (hydatid cyst)


    Drug of choice: Albendazole 7 7 400 mg bid × 28 days, repeated as necessary 15 mg/kg/d × 28 days, repeated as necessary
    Echinococcus multilocularis


    Treatment of choice: See footnote 7

    Crysticercus cellulosae (cysticercosis)


    Drug of choice: Albendazole 8 15 mg/kg/d in 2-3 doses × 8-28d, repeated as necessary 15 mg/kg/d in 2-3 doses × 8-28d, repeated as necessary

Praziquantel 8 50 mg/kg/d in 3 doses × 15d 50 mg/kg/d in 3 doses × 15d
OR

    Alternative: Surgery

Toxocariasis, see VISCERAL LARVA MIGRANS
TOXOPLASMOSIS (Toxoplasma gondii) 8


    Drugs of choice 8 : Pyrimethamine 7 25-100 mg/d × 3-4 wks 2 mg/kg/d × 3d, then 1 mg/kg/d (max. 25 mg/d) × 4 wks 8

plus sulfadiazine 1-1.5 grams qid × 3-4 wks 100-200 mg/kg/d × 3-4 wks
    Alternative: Spiramycin 8 3-4 grams/d 50-100 mg/kg/d × 3-4 wks
TRICHINOSIS (Trichinella spiralis)


    Drugs of choice: Steroids for severe symptoms


plus mebendazole 8 8 200-400 mg tid × 3d, then 400-500 mg tid × 10d
TRICHOMONIASIS (Trichomonas vaginalis)
    Drug of choice 8 : Metronidazole 2 grams once or 250 mg tid or 375 mg bid PO × 7d 15 mg/kg/d orally in 3 doses × 7d
OR Tinidazole 5 2 grams once 50 mg/kg once (max. 2 grams)
TRICHOSTRONGYLUS infection


    Drug of choice: Pyrantel pamoate 8 11 mg/kg once (max. 1 gram) 11 mg/kg once (max. 1 gram)
    Alternative: Mebendazole 8 100 mg bid × 3d 100 mg bid × 3d
OR Albendazole 400 mg once 400 mg once
TRICHURIASIS (Trichuris trichiura, whipworm)
    Drug of choice: Mebendazole 100 mg bid × 3d 100 mg bid × 3d
OR Albendazole 400 mg once 8 400 mg once 8
TRYPANOSOMIASIS


        T. cruzi (American trypanosomiasis, Chagas disease)
            Drug of choice: Nifurtimox 3 8 8-10 mg/kg/d in 4 doses × 120d 1-10 yrs: 15-20 mg/kg/d in 4 doses × 90d; 11-16 yrs: 12.5-15 mg/kg/d in 4 doses × 90d
            Alternative: Benznidazole 9 5-7 mg/kg/d × 30-120d
    T. brucei gambiense; T.b. rhodesiense (African trypanosomiasis, sleeping sickness) hemolymphatistage
    Drug of choice: Suramin 3 100-200 mg (test dose) IV, then 1 gram IV on days 1,3,7,14, and 21 20 mg/kg on days 1,3,7,14, and 21
OR Eflornithine See footnote 91
    Alternative: Pentamidine isethionate 8 4 mg/kg/d IM × 10d 4 mg/kg/d IM × 10d
    late disease with CNS involvement


    Drug of choice: Melarsoprol 3 9 2-3.6 mg/kg/d IV × 3d; after 1 wk 3.6 mg/kg per day IV × 3d; repeat again after 10-21 days 18-25 mg/kg total over 1 month; initial dose of 0.36 mg/kg IV, increasing gradually to max. 3.6 mg/kg at intervals of 1-5d for total of 9-10 doses
OR Eflornithine See footnote 91
    Alternatives: (T.b. gambiense only) Tryparasamide One injection of 30 mg/kg (max. 2g) IV every 5d to total of 12 injections; may be repeated after 1 month

plus suramin 3 One injection of 10 mg/kg IV every 5 d to total of 12 injections; may be repeated after 1 month
VISCERAL LARVA MIGRANS 9 (Toxocariasis)
    Drug of choice: Diethylcarbamazine 8 6 mg/kg/d in 3 doses × 7-10d 6 mg/kg/d in 3 doses × 7-10d
    Alternatives: Albendazole 400 mg bid × 3-5d 400 mg bid × 3-5d

Mebendazole 8 100-200 mg bid × 5d 100-200 mg bid × 5d
Whipworm, see TRICHURIASIS


Wuchereria bancrofti, see FILARIASIS


* The letter d stands for day.
 1 Entamoeba histolytica and E. dispar, until recently termed "pathogenic" and "nonpathogenic" E. histolytica, respectively, are morphologically indistinguishable.
 2 Dosage and duration of administration should not be exceeded because of possibility of causing optic neuritis; maximum dosage is 2 grams/day.
 3 In the USA, this drug is available from the CDC Drug Service, Centers for Disease Control and Prevention, Atlanta, Georgia 30333; telephone: 404-639-3670 (evenings, weekends, and holidays: 404-639-2888).
 4 Treatment should be followed by a course of iodoquinol or one of the other intraluminal drugs used to treat asymptomatic amebiasis.
 5 A nitro-imidazole similar to metronidazole, but not marketed in the USA; tinidazole appears to be at least as effective as metronidazole and better tolerated. Ornidazole, a similar drug, is also used outside the USA. Higher dosage is for hepatic abscess.
 6 Trophozoites and cysts of Acanthamoeba from infected corneas, contact lenses and their cases are susceptible in vitro to chlorhexidine, polyhexamethylene biguanide, propamidine, pentamidine, diminazine and neomycin and, especially, to combinations of these drugs (J Hay et al, Eye, 8:555, 1994). For treatment of itraconazole plus topical miconazole, have been successful (MB Moore et al, Br J Ophthalmol, 73:271, 1989; Y Ishabashi et al, Am J Ophthalmol, 109:121, 1990). Recently, 0.02% topical polyhexamethylene biguanide (PHMB) has been used successfully in a large number of patients (MJ Elder et al, Lancet, 345:791, 1995). PHMB is available as Baquacil (ICI America), a swimming pool disinfectant (E Yee and TK Winarko, Am J Hosp Pharm, 50:2523, 1993).
 7 Naegleria infections have been treated successfully with amphotericin B, rifampin and chloramphenicol (A Wang et al, Clin Neurol Neurosurg, 95:249, 1993), amphotericin B, oral rifampin and oral ketoconazole (N Poungvarin et al, J Med Assoc Thailand, 74:112, 1991), and amphotericin B alone (RL Brown, Arch Intern Med, 152:1330, 1992).
 8 An approved drug, but considered investigational for this condition by the U.S. Food and Drug Administration.
 9 Strains of Acanthamoeba isolated from fatal granulomatous amebic encephalitis are usually susceptible in vitro to pentamidine, ketoconazole (Nizoral), flucytosine and (less so) to amphotericin B. One patient with disseminated infection was treated successfully with intravenous pentamidine isethionate, topical chlorhexidine and 2% ketoconazole cream, followed by oral itraconazole (CA Slater et al, N Engl J Med, 331:85, 1994).
 10 Most patients recover spontaneously without antiparasitic drug therapy. Analgesics, corticosteroids, and careful removal of CSF at frequent intervals can relieve symptoms (J Koo et al, Rev Infect Dis, 10:1155, 1988). Albendazole, levamisole (Ergamisol), or ivermectin has also been used successfully in animais.
 11 This dose is likely to be toxic and may have to be decreased.
 12 Atovaquone suspension, 750 mg b.i.d., plus azithromycin, 500 to 1000 mg daily, may be effective when quinine and clindamycin fail. Exchange transfusion has been used in severely ill patients with high (>10%) parasitemia (V lacopino and T Earnhart, Arch Intern Med, 150:1527, 1990). One report indicates that azithromycin (Zithromax), 500-1000 mg daily, plus quinine may also be effective (LM Weiss et al, J Infect Dis, 168:1289, 1993). Concurrent use of pentamidine and trimethoprim-sulfamethoxazole has been reported to cure an infection with B. divergens (D Raoult et al, Ann Intern Med, 107:944, 1987).
 13 Not recommended for use in children less than eight years old.
 14 Drugs that could be tried include albendazole, mebendazole, thiabendazole, levamisole (Ergamisol) and ivermectin. Steroid therapy may be helpful, especially in eye and CNS infections. Ocular baylisascariasis has been treated successfully using laser photocoagulation therapy to destroy the intraretinal larvae.
 15 Clinical significance of these organisms is controversial, but metronidazole 750 mg tid × 10 d or iodoquinol 650 mg tid × 20d anecdotally has been reported to be effective (PFL Borehamand D Stenzel, Adv Parasitol, 32:2, 1993; JS Keystone, EK Markell, Clin Infect Dis, 21:102 and 104, July 1995).
 16 Infection is self-limited in immunocompetent patients. In HIV-infected patients paromomycin has limited effectiveness (AC White et al, J Infect Dis. 170:419, 1994; F Bissuel, Clin Infect Dis, 18:447, 1994). In unpublished clinical trials, azithromycin 1250 mg daily for two weeks followed by 500 mg daily, has apparently been effective in some patients.
 17 E Caumes et al, Am J Trop Med Hyg. 49:641, 1993; P Wolf et al, Hautarzt, 44:462, 1993; HD Davies et al, Arch Dermatol, 129:588, 1993.
 18 HIV-infected patients may need higher dosage and long-term maintenance (JW Pape et al, Ann Intern Med. 121:654, 1994).
 19 Not curative, but decreases inflammation and facilitates removing the worm. Mebendazole 400-800 mg/d for 6d has been reported to kill the worm directly.
 20 A single dose of invermectin, 20-200 µg/kg, has been reported to be effective for treatment of microfilaremia (SK Kar et al, Southeast Asian J Trop Med Public Health, 24:80, 1993).
 21 Antihistamines or corticosteroids may be required to decrease allergic reactions due to disintegration of microfilariae in treatment of filarial infections, especially those caused by Loa loa.
 22 For patients with no microfilariae in the blood, full doses can be given from day one.
 23 Diethylcarbamazine should be administered with special caution in heavy infections with Loa loa because rapid killing of microfilariae can provoke an encephalopathy. Ivermectin or albendazole has been used to reduce microfilaremia (Y Martin-Prevel et al, Am J Trop Med Hyg, 48:186, 1993; AD Klion et al, J Infect Dis, 168:202, 1993). Apheresis has been reported to be effective in lowering microfilarial counts in patients heavily infected with Loa loa (EA Ottesen, Infect Dis Clin North Am, 7:619, 1993). Diethylcarbamazine, 300 mg once weekly, has been recommended for prevention of loiasis (TB Nutman et al, N Engl J Med, 319:752, 1988).
 24 Diethylcarbamazine has no effect. Ivermectin, 150 µg/kg, may be effective (TB Nutman et al, J Infect Dis, 156:622, 1987).
 25 Unlike infections with other flukes, Fasciola hepatica infections may not respond to praziquantel. Recent data indicate that triclabendazole (Fasinex), a veterinary fasciolide, is safe and effective in a single oral dose of 10 mg/kg (W Apt et al, Am J Trop Med Hyg, 52:532, 1995).
 26 Unpublished data indicate triclabendazole (Fasinex), a veterinary fasciolide, may be effective in a dosage of 5 mg/kg once daily for 3 days or 10 mg/kg twice in one day.
 27 Furazolidone has been reported to be mutagenic and carcinogenic. Albendazole 400 mg daily × 5d may be effective (A Hall and Q Nahar, Trans R Soc Trop Med Hyg, 87:84, 1993). Bacitracin zinc or bacitracin 120,000 U bid for 10 days may also be effective (BJ Andrews et al, Am J Trop Med Hyg, 52:318, 1995).
 28 Not absorbed and not highly effective, but may be useful for treatment of giardiasis in pregnancy.
 29 Ivermectin has been reported to be effective in animals (MT Anantaphruti et al, Trop Med Parasitol, 43:65, 1992).
 30 P Kraivichian et al, Trans R Soc Trop Med Hyg, 86:418, 1992.
 31 In sulfonamide-sensitive patients, such as some HIV-infected patients, pyrimethamine 50-75 mg daily has been effective (LM Weiss et al, Ann Intern Med, 109:474, 1988). In immunocompromised patients, it may be necessary to continue therapy indefinitely.
 32 May be repeated or continued. A longer duration may be needed for some forms of visceral leishmaniasis.
 33 Limited data indicate that ketoconazole (Nizoral), 400 to 600 mg daily for four to eight weeks, may be effective for treatment of cutaneous leishmaniasis (RE Saenz et al, Am J Med, 89:147, 1990). Some studies indicate that L. donovani resistant to sodium stibogluconate or meglumine antimonate may respond to recombinant human gamma interferon in addition to antimony (R Badaro and WD Johnson, J Infect Dis, 167 suppl 1:S13, 1993), or pentamidine followed by a course of antimony (CP Thakur et al, Am J Trop Med Hyg, 45:435, 1991). Liposomal encapsulated amphoterici B (AmBisome, Vestar, San Dimas, CA) has been used successfully to treat multiple-drug-resistant visceral leishmaniasis (RN Davidson et al, QJ Med, 87:75, 1994; R Dietze et al, Clin Infect Dis, 17:981, 1993). Recently the combination of aminosidine (chemically identical to paromomycin) and sodium stibogluconate has been used to decrease the time to clinical cure of kala-azar (CP Thakur et al, Trans R Soc Trop Med Hyg, 89:219, 1995) and to cure diffuse cutaneous leishmaniasis caused by L. aethiopica (S Teklemariam et al, Trans R Soc Trop med Hyg, 88:334, 1994). In addition, preliminary studies suggest that aminosidine ointment appears to be effective in the treatment of cutaneous Old World leishmaniasis (ADM Bryceson et al, Trans R Soc Trop Med Hyg, 88:226, 1994).
 34 For infestation of eyelashes with crab lice use petrolarum.
 35 FDA-approved only for head lice.
 36 Some consultants recommend a second application one week later to kill hatching progeny.
 37 Chloroquine-resistant P. falciparum infections occur in all malarious areas except Central America west of the Panama Canal Zone, Mexico, Haiti, the Dominican Republic, and most of the Middle East (chloroquine resistance has been reported in Yemen, Oman and Iran).
 38 In Southeast Asia and possibly in other areas, such as South America, relative resistance to quinine has increased and the treatment should be continued for seven days.
 39 Fansidar tablets contain 25 mg of pyrimethamine and 500 mg of sulfadoxine. Resistance to pyrimethamine-sulfadoxine has been reported from Southeast Asia, the Amazon basin, East Africa, Bangladesh and Oceania.
 40 In pregnancy.
 41 For treatment of multiple-drug-resistant P. falciparum in Southeast Asia, especially Thailand, where resistance to mefloquine and halofantrine frequently occur, a 7-day course of quinine and tetracycline is recommended (G Watt et al, Am J Trop Med Hyg, 47:108, 1992). Combinations of artesunate plus mefloquine (C Luxemburger et al, Trans R Soc Trop Med Hyg, 88:213, 1994), artemether plus mefloquine (J Karbwang et al, Trans R Soc Trop Med Hyg, 89:296, 1995) or mefloquine plus tetracycline are also used to treat multiple-drug-resistant P. falciparum.
 42 At this dosage, adverse effects including nausea, vomiting, diarrhea, dizziness, disturbed sense of balance, toxic psychosis and seizures can occur. Mefloquine is teratogenic in animals and it has not been approved for use in pregnancy, but mefloquine prophylaxis has been reported to be safe and effective when used during the second half of pregnancy (F Nosten et al, J Infect Dis, 169:595, 1994). Limited studies also have demonstrated its efficacy in treating P. falciparum malaria during pregnancy (K Na Bangchang et al, Trans R Soc Trop Med Hyg, 88:321, 1994). It should not be given together with quinine or quinidine, and caution is required in using quinine or quinidine to treat patients with malaria who have taken mefloquine for prophylaxis. The pediatric dosage has not bee approved by the FDA. Resistance to mefloquine has been reported in some areas, such as the Thailand-Myanmar border and the Amazon region, where 25 mg/kg should be used.
 43 In the USA, a 250-mg tablet of mefloquine contains 228 mg of mefloquine base. Outside the USA, each 275-mg tablet contains 250 mg base.
 44 750 mg followed 6-8 hours later by 500 mg.
 45 NJ White, Eur J Clin Pharmacol, 34:1, 1988.
 46 May be effective in multiple-drug resistant P. falciparum malaria, but treatment failures and resistance have been reported, and the drug causes consistent dose-related lengthening of the PR and Qtc intervals (A Castot et al, Lancet, 341:1541, 1993). Several patients have developed first degree block (F Nosten et al, Lancet 341:1054, 1993). The micronized form of halofantrine has improved its bioavailability, but variability in absorption remains an important problem (J Karbwang et al, Clin Pharmacokinet, 27:104, 1994). It should not be taken one hour before to three hours after meals and should not be used for patients with cardiac conduction defects. Cardiac monitoring is recommended.
 47 One study found artemether, a Chinese drug, effective for parenteral treatment of severe malaria in children (NJ White et al, Lancet, 339:317, 1992).
 48 Exchange transfusion has been helpful for some patients with high-density (>10%) parasitemia, altered mental status, pulmonary edema or renal complications (JR Zucker and CC Campbell, Infect Dis Clin North Am, 7:547, 1993).
 49 Continuous EKG, blood pressure and glucose monitoring are recommended.
 50 Quinidine may have greater antimalarial activity than quinine. The loading dose should be decreased or omitted in those patients who have received quinine or mefloquine. If more than 48 hours of parenteral treatment is required, the quinine or quinidine dose should be reduced by 1/3 to 1/2.
 51 Not available in the USA. With IV administration of quinine dihydrochloride, monitoring of EKG and blood pressure is recommended. Use of parenteral quinine or quinidine may also lead to severe hypoglycemia; blood glucose should be monitored.
 52 If chloroquine phosphate is not available, hydroxychloroquine sulfate is as effective; 400 mg of hydroxychloroquine sulfate is equivalent to 500 mg of chloroquine phosphate.
 53 In P. falciparum malaria, if the patient has not shown a response to conventional doses of chloroquine in 48-72 hours, parasitic resistance to this drug should be considered. P. vivax with decreased susceptibility to chloroquine has been reported from Papua-New Guinea, Brazil, Myanmar, India, Colombia, and Indonesia; a single dose of mefloquine, 15 mg/kg, has been recommended to treat these infections.
 54 Some relapses have been reported with this regimen; relapses should be treated with chloroquine plus primaquine, 22.5 to 30 mg base/d × 14 days.
 55 Primaquine phosphate can cause hemolytic anemia, especially in patients whose red cells are deficient in glucose-6-phosphate dehydrogenase. This deficiency is most common in Africa, Asia, and Mediterranean peoples. Patients should be screened for G-6-PD deficiency before treatment. Primaquine should not be used during pregnancy.
 58 For prevention of attack after departure from areas where P. vivax and P. ovale are endemic, which includes almost all areas where malaria is found (except Haiti), some experts prescribe in addition primaquine phosphate 15 mg base (26.3 mg)/d or, for children, 0.3 mg base/kd/g during the last two weeks of prophylaxis. Others prefer to avoid the toxicity of primaquine and rely on surveillance to detect cases when they occur, particularly when exposure was limited or doubtful. See also footnote 54 and 55.
 59 Beginning one week before travel and continuing weekly for the duration of stay and for four weeks after leaving.
 61 The pediatric dosage has not been approved by the FDA, and the drug has not been approved for use during pregnancy. Women should take contraceptive precautions while taking mefloquine and for two months after the last dose. Mefloquine is not recommended for patients with cardiac conduction abnormalities. Patients with a history of seizures or psychiatric disorders and those whose occupation requires fine coordination or spatial discrimination should probably avoid mefloquine (Medial Letter, 32:13, 1990). Resistance to mefloquine has been reported in some areas, such as Thailand; in these areas, doxycycline should be used for prophylaxis.
 62 Beginning one day before travel and continuing for the duration of stay and for four weeks after leaving. Use of tetracyclines is contraindicated in pregnancy and in children less than eight years old. Doxycycline can cause gastrointestinal disturbances, vaginal moniliasis and phorosensitivity reactions.
 63 Proguanil (Paludrine--Ayerst, Canada; ICI, England), which is not available in the USA but is widely available overseas, is recommended mainly for use in Africa south of the Sahara. Prophylaxis is recommended during exposure and for four weeks afterwards. Failures in prophylaxis with chloroquine and proguanil have been reported in travelers to Kenya (AJ Barnes, Lancet, 338:1338, 1991).
 64 Ocular lesions due to E. hellem in HIV-infected patients have responded to fumagillin eyedrops prepared from Fumidil-B, a commercial product used to control a microsporidial disease of honey bees, available from Mid-Continent Agrimarketing, Inc., Lenexa, Kansas 66215 (MC Diesenhouse, Am J Ophthalmol, 115:293, in an HIV-infected patient was treated successfully with surgical debridement, topical antibiotics and itraconazole (RW Yee et al, Ophthalmology, 97:953, 1990).
 65 Albendazole, 400 mg bid may be effective for S. intestinalis infections (C Blanshard et al, AIDS, 6:311, 1992) and may be helpful for E. bieneusi infections (DT Dieterich et al, J Infect Dis, 169:178, 1994). Octreotide (Sandostatin) has provided symptomatic relief in some patients with large volume diarrhea.
 66 Albendazole 400 mg bid may be effective for E. hellem and E. cuniculi. There is no established treatment for Pleistophora.
 67 Albendazole or pyrantel pamoare may be effective (HP Krepel et al, Trans R Soc Trop Med Hyg, 87:87, 1993).
 68 In severe disease with room air Po2 70 mmHg or Aa gradient 35 mmHg, prednisone should also be used (see Medical Letter, 37:89, Oct 13, 1995).
 69 HIV-infected patients should be treated for 21 days.
 70 For patients who have failed or are intolerant to trimethoprim-sulfamethoxazole.
 71 Plus folinic acid, 10 mg, with each dose of pyrimethamine.
 72 Neuropsychiatric disturbances and seizures have been reported in some patients (H Stokvis et al, Am J Trop Med Hyg, 35:330, 1986).
 73 In East Africa, the dose should be increased to 30 mg/kg, and in Egypt and South Africa, 30 mg/kg/d × 2d. Some experts recommend 40-60 mg/kg over 2-3 days in all of Africa (KC Shekhar, Drugs, 42:379, 1991).
 74 In immunocompromised patients, it may be necessary to prolong therapy or use other agents.
 75 In disseminated strongyloidiasis, thiabendazole therapy should be continued for at least five days.
 76 C Naquira et al, Am J Trop Med Hyg, 40:304, 1989; M Lyagoubi et al, Trans R Soc Trop Med Hyg, 86:541, 1992; PH Gann et al, J Infect Dis, 169:1076, 1994.
 77 With a fatty meal to enhance absorption. Some patients may benefit from or require surgical resection of cysts (RK Tompkins, Mayo Clinic Proc, 66:1281, 1991). Praziquantel may also be useful preoperatively or in case of spill during surgery.
 78 Percutaneous drainage with ultrasound guidance plus albendazole therapy has been effective for management of hepatic hydatid cyst disease (MS Khuroo et al, Gastroenterology, 104:1452, 1993).
 81 Albendazole should be taken with a fatty meal to enhance absorption.
 82 In ocular taxoplasmosis, corticosteroids should also be used for an anti-inflammatory effect on the eyes.
 83 To treat CNS toxoplasmosis in HIV-infected patients, some clinicians have used pyrimethamine 50 to 100 mg daily after a loading dose of 200 mg with a sulfonamide and, when sulfonamide sensitivity developed, have given clindamycin 1.8 to 2.4 g/d in divided doses instead of the sulfonamide (JS Remington et al, Lancet, 338:1142, 1991; BJ Luft et al, N Engl J Med, 329:995, 1993). Atovaquone plus pyrimethamine appears to be an effective alternative in sulfa-intolerant patients (JA Kovacs et al, Lancet, 340:637, 1992). Dapsone-pyrimethamine can prevent first episodes of toxoplasmosis (P-M Girard et al, N Engl J Med, 328:1514, 1993).
 84 Congenitally infected newborns should be treated with pyrimethamine every two or three days and a sulfonamide daily for about one year (JS Remington and G Desmonts in JS Remington and JO Klein, eds, Infectious Disease of the Fetus and Newborn Infant, 4th ed, Philadelphia: Saunders, 1995, page 140).
 85 For use during pregnancy, continue the drug until delivery. It it has been determined that transmission has occurred in utero, then therapy with pyrimethamine and sulfadiazine should be started.
 86 Albendazole or flubendazole (not available in the USA) may also be effective.
 87 Sexual partners should be treated simultaneously. Outside the USA, ornidazole has also been used for this condition. Metronidazole-resistant strains have been reported; higher doses of metronidazole for longer periods are sometimes effective against these strains (J Lossick, Rev Infect Dis, 12:S665, 1990). Experimental studies suggest that bacitracin and bacitracin zinc have microbicidal activity against multiple isolates of T. vaginalis (BJ Andrews et al, Trans R Soc Trop Med Hyg, 88:704, 1994).
 88 In heavy infection it may be necessary to extend therapy for 3 days.
 89 The addition of gamma interferon to nifurtimox for 20 days in a limited number of patients and in experimental animals appears to have shortened the acute phase of Chagas disease (RE McCabe et al, J Infect Dis, 163:912, 1991).
 90 Limited data.
 92 In frail patients, begin with as little as 18 mg and increase the dose progressively. Pretreatment with suramin has been advocated for debilitated patients. Corticosteroids have been used to prevent arsenical encephalopathy (J Pepin et al, Trans R Soc Trop Med Hyg, 89:92, 1995).
 93 For severe symptoms or eye involvement, corticosteroids can be used in addition.



P660

TABLE 5-9 -- Manufacturers of Antiparasitic Drugs
* albendazole--Zentel (SmithKline Beecham)
* aminosidine (paromomycin)
    atovaquone--Mepron (Glaxo-Wellcome)
    bacitracin--many manufacturers
* bacitracin-zinc (Apothekernes Laboratorium A.S., Oslo, Norway

* benznidazole--Rochagan (Roche, Brazil)

bithionol--Bitin (Tanabe, Japan)
    chloroquine--Aralen (Sanofi Winthrop), others
    crotamiton--Eurax (Westwood-Squibb) Dapsone (Jacobus)
* diethylcarbamazine--Hetrazan (Wyeth-Ayerst)
diloxanide furoate--Furamide (Boots, England)
* eflornithine (difluoromethylornithine, DFMO)--Ornidyl (Merrell Dow)
* flubendazole--(Janssen)
    furazolidone--Furoxone (Roberts)
* halofantrine--Halfan (SmithKline Beecham)
    hydroxychloroquine--Plaquenil (Sanofi Winthrop) iodoquinol (diiodohydroxyquin)--Yodoxin (Glenwood), others
ivermectin--Mectizan (Merck)
* malathion--Prioderm
    mebendazole--Vermox (Janssen)
    mefloquine--Lariam (Roche)
* meglumine antimonate--Glucantime (Rhone-Poulenc Rorer, France)
melarsoprol--Arsobal (Rhone-Poulenc Rorer, France)
    metronidazole--Flagyl (Searle), others
nifurtimox--Lampit (Bayer, Germany)
* ornidazole--Tiberal (Hoffman-LaRoche, Switzerland)
    oxamniquine--Vansil (Pfizer)
    paromomycin--Humatin (Parke-Davis)
    pentamidine isethionate--Pentam 300 (Fujisawa), NebuPent (Fujisawa)
    permethrin--Nix (Glaxo-Wellcome), Elimite (Herbert), Lyclear (Canada)
    praziquantel--Biltricide (Miles)
    primaquine phosphate--(Sanofi Winthrop)
* proguanil--Paludrine (Ayerst, Canada, ICI, England)
    pyrantel pamoate--Antiminth (Pfizer)
    pyrethrins and piperonyl butoxide--RID (Pfizer), others
    pyrimethamine--Daraprim (Glaxo-Wellcome)
    pyrimethamine-sulfadoxine--Fansidar (Roche)
    quinidine gluconate--(Lilly)
* quinine dihydrochloride
    quinine sulfate--many manufacturers
sodium stibogluconate (antimony sodium gluconate) -- Pentostam (Glaxo-Wellcome, England)
* spiraycin--Rovamycine (Rhone-Poulenc Rorer)
    sulfadiazine--(Eon Labs, and others)
suramin--(Bayer, Germany)
    thiabendazole--Mintezol (Merck)
* tinidazole--Fasigyn (Pfizer)
* triclabendazole (Ciba-Geigy)
    trimetrexate--Neutrexin (US Bioscience)
* tryparsamide
* Available in the USA only from the manufacturer.
 ** Not available in the USA.
 Available from the CDC Drug Service, Centers for Disease Control and Prevention, Atlanta, Georgia 30333; 404-639-3670 (evenings, weekends, or holidays: 404-639-2888).



P661

TABLE 5-10 -- Adverse Effects of Some Antiparasitic Drugs *
ALBENDAZOLE (Zentel)
    Occasional: diarrhea; abdominal pain; migration of ascaris through mouth and nose
    Rare: leukopenia; alopecia; increased serum transaminase activity
AMINOSIDINE--See Paromomycin
ATOVAQUONE (Mepron)
    Frequent: rash, nausea
    Occasional: diarrhea
BACITRACIN
    Frequent: nephorotxicity
    Occasional: rash
    Rare: anaphylaxis
BENZNIDAZOLE (Rochagan)
    Frequent: allergic rash; dose-dependent polyneuropathy; gastrointestinal disturbances; psychic disturbances
BITHIONOL (Bitin)
    Frequent: photosensitivity reactions; vomiting; diarrhea; abdominal pain; urticaria
    Rare: leukopenia; toxic hepatitis
CHLOROQUINE HCI and CHLOROQUINE PHOSPHATE (Aralem, and others)
    Occasional: pruritis; vomiting; headache; confusion; depigmentation of hair; skin eruptions; corneal opacity; weigh loss; partial alopecia; extraocular muscle palsies; exacerbation of psoriasis, eczema, and other exfoliative dermatoses; myalgias; photophobia
Rare: irreversible retinal injury (especially when total dosage exceeds 100 grams); discoloration of nails and mucus membranes; nerve-type deafness; peripheral neuropathy and myopathy; heart block; blood dyscrasias; hematemesis
CROTAMITON (Eurax)
    Occasional: rash, conjunctivitis
DAPSONE
    Frequent: rash; transient headache; GI irritation; anorexia; infectious mononucleosis-like syndrome
    Occasional: cyanosis due to methemoglobinemia and sulfhemoglobinemia; other blood dyscrasias, including hemolytic anemia; nephrotic syndrome; liver damage; peripheral neuropathy; hypersensitivity reactions; increased risk of lepra reactions; insomnia; irritability; uncoordinated speech; agitation; acute psychosis
    Rare: renal papillary necrosis; severe hypoalbuminemia; epidermal necrolysis; optic atrophy; agranulocytosis; neonatal hyperbilirubinemia after use in pregnancy
DIETHYLCARBAMAZINE CITRATE USP (Hetrazan)
    Frequent: flatulence
    Occasional: nausea; vomiting; diarrhea
    Rare: diplopia; dizziness; urticaria; pruritus
EFLORNITHINE (Difluoromethylornithine, DFMO, Ornidyl)
    Frequent: anemia; leukopenia
    Occasional: diarrhea; thrombocytopenia; seizures
    Rare: hearing loss
FLUBENDAZOLE--similar to mebendazole
FURAZOLIDONE (Furoxone)
    Frequent: nausea; vomiting
    Occasional: allergic reactions, including pulmonary infiltration, hypotension, urticaria, fever, vesicular rash; hypoglycemia; headache
    Rare: hemolytic anemia in G-6-PD deficiency and neonates; disulfiram-like reaction with alcohol; MAO-inhibitor interactions; polyneuritis
HALOFANTRINE (Halfan)
    Occasional: diarrhea; abdominal pain; pruritus; prolongation of Qtc and PR interval
IODOQUINOL (Yodoxin)
    Occasional: rash; acne; slight enlargement of the thyroid gland; nausea; diarrhea; cramps; anal pruritus
    Rare: optic neuritis; optic atrophy, loss of vision, peripheral neuropathy after prolonged use in high dosage (for months); iodine sensitivity
IVERMECTIN (Mectizan)
    Occasional: Mazzotti-type reaction seen in onchocerciasis, including fever, pruritus, tender lymph nodes, headache, and joint and bone pain
    Rare: hypotension
MALATHION (Prioderm)
    Occasional: local irritation
MEBENDAZOLE (Vermox)
    Occasional: diarrhea; abdominal pain; migration of ascaris through mouth and nose
    Rare: leukopenia; agranulocytosis; hypospermia
MEFLOQUINE (Lariam)
    Frequent: vertigo; lightheadedness; nausea; other gastrointestinal disturbances; nightmares; visual disturbances; headache
    Occasional: confusion
    Rare: psychosis; hypotension; convulsions; coma; paresthesias
MEGLUMINE ANTIMONATE (Glucantime) Similar to sodium stibogluconate
MELARSOPROL (Arsobal)
    Frequent: nausea; headache; dry mouth; metallic taste
    Occasional: vomiting; diarrhea; insomnia; weakness; stomatitis; vertigo; tinnitus; paresthesias; rash; dark urine; urethral burning; disulfiram-like reaction with alcohol
    Rare: seizures; encephalopathy; pseudomembranous colitis; ataxia; leulopenia; peripheral neuropathy; pancreatitis
NIFURTIMOX (Lampit)
    Frequent: anorexia; vomiting; weight loss; loss of memory; sleep disorders; tremor; paresthesias; weakness; polyneuritis
    Rare: convulsions; fever; pulmonary infiltrates and pleural effusion
ORNIDAZOLE (Tiberal)
    Occasional: dizziness; headache; gastrointestinal disturbances
    Rare: reversible peripheral neuropathy
OXAMNIQUINE (Vansil)
    Occasional: headache; fever; dizziness; somnolence; nausea; diarrhea; rash; insomnia; hepatic enzyme changes; ECG changes; EEG changes; orange-red discoloration of urine
    Rare: seizures; neuropsychiatric disturbances
PAROMOMYCIN; (aminosidine; Humatin)
    Frequent: GI disturbances with oral use
    Occasional: eighth-nerve damage (mainly auditory) and renal damage when aminosidine is given IV; vertigo; pancreatitis
PENTAMIDINE ISETHIONATE (Pentam 300, NebuPent)
    Frequent: hypotension; hypoglycemia often followed by diabetes mellitus; vomiting; blood dyscrasias; renal damage; pain at injection site; GI disturbances
    Occasional: may aggravate diabetes; shock; hypocalcemia; liver damage; cardiotoxicity; delirium; rash
    Rare: Herxheimer-type reaction; anaphylaxis; acute pancreatitis; hyperkalemia
PERMETHRIN (Nix, Elimite)
    Occasional: burning; stinging; numbness; increased pruritus; pain; edema; erythema; rash
PRAZIQUANTEL (Biltricide)
    Frequent: malaise; headache; dizziness
    Occasional: sedation; abdominal discomfort; fever; sweating; nausea; eosinophilia; fatigue
    Rare: pruritus; rash
PRIMAQUINE PHOSPHATE USP
    Frequent: hemolytic anemia in G-6-PD deficiency
    Occasional: neutropenia; GI disturbances; methemoglobinemia
    Rare: CNS symptoms; hypertension; arrhythmias
PROGUANIL (Paludrine)
    Occasional: oral ulceration; hair loss; scaling of palms and soles; urticaria
    Rare: hematuria (with large doses); vomiting; abdominal pain; diarrhea (with large doses); thrombocytopenia
PYRANTEL PAMOATE (Antiminth)
    Occasional: GI disturbances; headache; dizziness; rash; fever
PYRETHRINS and PIPERONYL BUTOXIDE (RID, others)
    Occasional: allergic reactions
PYRIMETHAMINE USP (Daraprim)
    Occasional: blood dyscrasias; folic acid deficiency
    Rare: rash; vomiting; convulsions; shock; possibly pulmonary eosinophilia; fatal cutaneous reactions with pyrimethamine-sulfadoxine (Fansidar)
QUININE DIHYDROCHLORIDE and SULFATE
    Frequent: cinchonism (tinnitus, headache, nausea, abdominal pain, visual disturbance)
    Occasional: deafness; hemolytic anemia; other blood dyscrasias; photosensitivity reactions; hypoglycemia; arrhythmias; hypotension; drug fever
    Rare: blindness; sudden death if injected too rapidly
SODIUM STIBOGLUCONATE (Pentostam)
    Frequent: muscle and joint pain; fatigue; nausea; transaminase elevations; T-wave flattening or inversion; pancreatitis
    Occasional: weakness; abdominal pain; liver damage; bradycardia; leukopenia; thrombocytopenia; rash; vomiting
    Rare: diarrhea; pruritus; myocardial damage; hemolytic anemia; renal damage; shock; sudden death
SPIRAMYCIN (Rovamycine)
    Occasional: GI disturbances
    Rare: allergic reactions
SURAMIN SODIUM
    Frequent: vomiting; pruritus; urticaria; paresthesias; hyperesthesia of hands and feet; photophobia; peripheral neuropathy
    Occasional: kidney damage; blood dyscrasias; shock; optic atrophy
THIABENDAZOLE (Mintezol)
    Frequent: nausea; vomiting; vertigo; headache; drowsiness; pruritus
    Occasional: leukopenia; crystalluria; rash; hallucination and other psychiatric reactions; visual and olfactory disturbance; erythema multiforme     Rare: shock; tinnitus; intrahepatic cholestasis; convulsions; angioneurotic edema; Stevens-Johnson syndrome
TINIDAZOLE (Fasigyn)
    Occasional: metallic taste; nausea; vomiting; rash
TRIMETREXATE (with "leucovorin rescue")
    Occasional: rash; peripheral neuropathy; bone marrow depression; increased serum aminotransferase activity
TRYPARSAMIDE
    Frequent: nausea; vomiting
    Occasional: impaired vision; optic atrophy; fever; exfoliative dermatitis; allergic reactions; tinnitus
* Drug interactions are generally not included here; see the current edition of The Medical Letter Handbook of Adverse Drug Interactions.

MD Consult L.L.C.   http://www.mdconsult.com
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