1. ANTHELMINTIC DRUGS Helminth Infections 1-Tapeworms ( cestodes) Beef tapeworm / fish tapeworm 2- Intestinal round worms ( nematodes) Ascaris, pinworm ,whipworm, strongyloides, ancylostoma ( hookworm ). A skin infection is termed cutaneous larva migrans
Visceral larva migrans .

2. Anthelminthic Drugs *Worms or larvae live in tissues of host
May act by causing :
1- paralysis of the worm.
2- damaging the worm leading to partial digestion or rejection by immune mechanisms.
3- interfere with the metabolism of the worm.
*Worms or larvae live in tissues of host
body like muscles , viscera , menninges ,
subcutaneous tissues.

3. Adult filariae live in the lymphatics, connective tissue or mesentery of host and produce live embryos or microfilariae, which goes to blood stream.
They are ingested by mosquitoes or similar insects, they develop to larvae in 2ndry host and pass to mouth parts of insect and
re-injected to humans

4. Ascaris lumbricoids ( common round worm)

5. filariasis

6. Hookworm

7. Pinworm male ,female

8. Tapeworm

9. whipworm

10. Dircrocoelium dendriticum

11. Fasiola hepatica

12. Tricuris tricura

13. Trichinela spiralis

14. elephantiasis

15. Hydateid cyct

16. cysticercosis

17. ANTHELMINTIC DRUGS ALBENDAZOLE Broad spectrum oral anthelmintic
Drug of choice for treatment of hydatid disease and cysticercosis,it is also used for the treatment of ascariasis ,tricurasis and strongyloidiasis, pinworm, hookworm

18. Mechanism Of Action
Inhibits microtubule synthesis by binding to β –tubulin.
Inhibits mitochondrial reductase causing reduced glucose transport.. Intestinal parasites are immobilized and die slowly.
larvicidal in hydatid ,cysticercosis , ascariasis and hook worm infections.
Ovicidal in ascariasis ,hookworm , trichuriasis

19. Pharmacokinetics Benzimidazole carbamate
Administered orally , absorption increased with a fatty meal
Metabolized in the liver to the active metabolite albendazole sulfoxide

20. Pharmacokinetics Plasma half life is 8-12 hours
sulfoxide is mostly protein bound distributes well to tissues and enters bile,CSF & hydatid cysts.
Metabolites are excreted in urine

21. Clinical uses
Used on empty stomach when used against intraluminal parasites but with a fatty meal when used against tissue parasites.
In ascariasis ,trichuriasis ,hookworm, pin worm infections : children over 2 years & adults (single dose 400mg, repeated for 2-3 day in heavy ascaris infection . For 2 wks for pin worm infection
2. Hydatid diseases:
drug of choice for medical therapy& adjunctive to surgical removal or aspiration of cysts.

22. Albendazole (con’) Neurocysticercosis:
Used with corticosteroid to decrease the inflammation caused by dying organism and it also reduces the duration of course for 21 days
4. Other infections: Drug of choice in cutaneous and visceral larva migrans , intestinal capillariasis, giardiasis & taeniasis.

23. Adverse Effects
In short term(1-3 days): Mild epigastric pain,diarrhea, nausea, headache & insomnia.
In long term use : for hydatid cyst and cysticercosis : abdominal pain, headache ,fever ,fatigue, alopecia , increased liver enzymes , pancytopenia. Blood counts and liver enzymes should be followed.
Not given during pregnancy, hypersensitive people to benzimidazole drugs & children under 2 years .

24. MEBENDAZOLE (Vermox) Synthetic benzimidazole
Wide spectrum and low incidence of adverse effects
Mechanism of action:
Inhibits microtubule synthesis .
It kills hookworm, pin worm , ascaris and trichuris eggs.

25. Pharmacokinetics less than 10% of orally administered drug is absorbed
Absorption increases with fatty meal.
Absorbed drug is 90 % protein bound
Converted to inactive metabolites .
Half- life of 2-6 hours
Excreted mostly in urine .

26. Clinical Uses
It is taken orally before or after meal , tablets should be chewed before swallowing.
Pinworm , trichuriasis, hookworm & ascaris infections.
in adults and children over 2 years cure rate is % except hookworm it is less.

27. Adverse Effects & Precautions
Short term therapy.Mild GI disturbance.
High dose : hypersensitivity reactions, agranulocytosis , alopecia ,elevation of liver enzymes .
Used with caution under 2ys of age may cause convulsion.
Contraindicated in pregnancy.
Enzyme inducers and inhibitors affect plasma level of the drug.

28. Thiabendazole Benzimidazole
Chelating agent and form stable complexes with metals including iron, but does not bind with calcium.
Rapidly absorbed
Half- life of 1-2 hrs
Completely metabolized in liver and 90% is excreted in urine
Can also absorbed through skin

29. Mechanism Of Action
Similar to other benzimidazoles. It is ovicidal for some parasites
Clinical uses:
Should be given after meals .and tablets should be chewed
Strongyloidal infections & cutaneous larva migrans .Thiabendazole cream is applied topically or drug can be given orally for 2 days.

30. Adverse Effects & Contraindications
More toxic than other benzamidazoles
GI disturbances
Pruritus ,headache, drowsiness , psychoneurotic symptoms.
Irreversible liver failure.
Fatal Stevens –Johnson syndrome
Not used in young children , pregnancy, hepatic and renal diseases.

31. PYRANTEL PAMOATE Mechanism of action: Broad spectrum Pharmacokinetics:
Poorly absorbed from GIT
Half of the drug is excreted unchanged in the feces.
Mechanism of action:
result in paralysis of worms. It is a neuromuscular blocking agent
Efficacy
Very effective against luminal organisms( mature or immature forms).
Not effective against migratory stages in the tissues or against ova

32. Clinical uses Pin worm given orally with or without food. Ascariasis
Hookworm

33. Adverse Effects Infrequent mild transient GI disturbance
drowsiness , headache ,insomnia.
Rash ,fever
Contraindications & Cautions
Should be used with caution in liver dysfunction.
Pregnancy
Children under 2 years of age

34. PIPERAZINE Mechanism of action:
Only recommended for the treatment of ascariasis cure rate 90% for 2 days treatment.
Readily absorbed orally and excreted mostly unchanged in urine
Mechanism of action:
Causes paralysis of ascaris by blocking acetylcholine at myoneural junction , the live worms expelled by normal peristalsis.

35. Treatment is continued for 3-4 days or repeated after one week in case of heavy infections.

36. Adverse Effects GI disturbance Neurotoxicity ,allergic reactions .
Contraindications
Epilepsy or a history of epilepsy
Impaired liver or kidney functions
pregnancy
Chronic neurologic disease

37. NICLOSAMIDE
Second-line drug for treatment of most tapeworm infections.
Mechanism of action:
Adult worm( not ova) is rapidly killed by inhibition of oxidative phosphorylation .
Pharmacokinetics:
Poorly absorbed from gut & excreted in urine.

38. Clinical Uses Treatment of most forms of tapeworms.
Not effective against cysticercosis or hydatic disease.
Given in the morning on empty stomach.
Purgative is necessary to purge all dead segments& prevent liberation of ova.

39. Adverse effects & Contraindications
Mild ,infrequent and transitory GI disturbance
Alcohol consumption should be avoided
Not indicated in children under 2 years of age or in pregnancy.

40. DIETHYL CARBAMAZINE
Drug of choice for the treatment of filariasis and tropical eosinophilia.
Pharmacokinetics:
Rapidly absorbed from gut
Half- life is 2-3 hours
The drug should be given after meals
It is excreted in urine as unchanged or metabolite.
Dosage is reduced in urinary alkalosis and renal impairment.

41. Mechanism Of Action
Immobilizes microfilariae and alters their surface structure ,displacing them from tissues & making them susceptible to destruction by host defense mechanism
It has immunosuppressive effects

42. Adverse Effects
Fever , malaise, papular rash, headache, GI disturbance,cough. Chest,muscle,joint pain
Leucocytosis
Retinal hemorrhage
Encephalopathy
lymphangitis and lymphadenopathy.
*It is not teratogenic

43. Contraindications & Cautions
* Hypertension
* Renal disease
*patient with lymphangitis

44. IVERMECTIN Drug of choice for treatment of strongyloidiasis
Macrocyclic lactone ring
Given only orally
Rapidly absorbed
Does not cross BBB.
Half- life is 16 hrs
Excretion is mainly in feces.

45. Mechanism Of Action
Acts on the parasitte,s glutamate-gated Cl- channel receptors . Chloride influx increased , hyperpolarization occurs , resulting in paralysis of the worm. Or
Paralyze nematodes by intensifying GABA- mediated transmission of signals in peripheral nerves.

46. Clinical uses
Drug of choice for cutaneous larva migrans & strongyloidiasis.
Onchocerciasis
It is also used for scabies , lice .
Filariasis.

47. Adverse Effects Fatigue ,dizziness, GI disturbance
Killing of microfilaria result in a Mazotti reaction ( fever, headache, dizziness, somnolence, hypotension , tachycardia, peripheral edema……).
Corneal opacities & other eye lesions.

48. Contraindications & Cautions
Concomitant use with other drugs that enhance GABA
e.g Barbiturates, bnzodiazepines, valproic acid.
pregnancy
Meningitis
Children under 5 years of age.

49. BITHIONOL
Drug of choice for the treatment of fascioliasis ( sheep liver fluke)
Pharmacokinetics:
It is orally administered and excreted in urine.

50. Adverse Effects GI disturbance ( N., V., D., A.) Dizziness, headache
Skin rashes , urticaria, Leucopenia
Contraindications and precautions:
Hepatitis , leucopenia
Used with caution in children under 8 years of age.