1. Dr.Mohamed Abd AlMoneim Attia
Antihelmintic drugs By
Dr.Mohamed Abd AlMoneim Attia

2. Antihelmintic drugs Drugs active against cestodes
Drugs active against nematodes
Drugs active against trematodes
Niclosamide
Praziquantel
Albendazole
mebendazole
Diethylcarbamazine (systemic)
Albendazole
Mebendazole
Pyrantel pamoate
Ivermectin
Praziquantel
Metrifonate
oxamnquine

3. Drugs active against nematodes
Intestinal nematodes includes:
1-enterobius vermicularis (pinworm)
2-ascaris lumbricoides (roundworm)
3-ancyclostoma & necator species (hookworm)
4-strongyloides stercoralis (threadworm)
Tissue nematodes: onchocerca,filariasis

4. pinworm
hookworm
Round worm
threadworm

5. Albendazole Mechanism of action:
block glucose uptake by the parasite leading to decrease production of energy and subsequent parasite immobilization
Uses:
1-treatment of roundworm,pinworm,hookworm infection
2-alternative treatment of threadworm,filariasis
3-hydatid disease & cysticercosis

6. Side effects:
1- short course treatment :has few side effects
2-long course treatments: leucopenia, alopecia & elevation of liver enzymes

7. Diethylcarbamazine Mechanism of action:
Immobilizes microfilaria by unknown mechanism increase host susceptibility to attack it.
Uses:
Drug of choice in filarial
infection of the eye (loa loa)
Alternate drug in elephantiasis.

8. Side effects:
1-headache,malasie,weakness,nausea
2-reaction to dying filaria includes: fever, rash,ocular damage, joint pain and lymphangitis

9. Ivermectin
Mechanism of action: facilitates GABA mediated neurotransmission in nematodes causing immobilization of the parasite, facilitating its removal by reticuloendothelial system.
Uses:
Drug of choice in treatment of onchocercosis, and threadworm infection

10. Side effects:
Mazzotti reactions(due to killing of microfilaria) and includes,fever, joint pain, rash hypotension,tachycardia

11. Mebendazole Mechanism of action:
Inhibit glucose uptake and microtubule synthesis in nematodes.
Uses:
Primary drug in roundworm and pinworm infection
Side effects:
GIT upsets, alopecia and agranulocytosis in high dose

12. Piperazine Mechanism of action:
Act as GABA receptor agonist causing paralysis of the parasite and expelled live by normal intestinal peristalsis
Uses: alternate drug in treatment of roundworm infection.
Side effects: GIT upsets, teratogenic

13. Pyrantel pamoate Mechanism of action:
Stimulate nicotinic receptor present at the NMJ of nematode.contraction of the muscle occurs followed by depolarization induced paralysis.
Uses:
1- drug of choice for hookworm & roundworm infection
2-alternate drug in pinworm infection
Side effects: mild GIT upsets

14. Thiabendazole Mechanism of action: like mebendazole
Uses: alternate drug in threadworm infection
Side effects: unsafe drug
1-GIT irritation,headache,drowsiness
2-leukopenia,haematuria
3-allergic reaction

15. Drugs active against trematodes
Medically important trematodes are:
1-schistosoma species (blood fluke)
2-clonorchis sinesis (liver flukes in southeast Asia)
3-paragonimus westermani ( lung fluke in Asia,India)

16. Praziquantel Mechanism of action:
Increase membrane permeability to calcium causing muscle contraction followed by paralysis leading to vacuolization and death of the parasite.
Uses:
1- drug of choice of all trematodes infection
2-one of 2 drugs of choice in cestodes infection

17. Side effects:
1-common adverse effects: GIT upset,headach,malaise,skin rash
2-intracranial hypertension and convulsion if used in ttt of neurocysticercosis
Contraindication: ocularcysticercosis

18. Bithionol
Uses:
Drug of choice in ttt of fascioliasis ( sheep liver fluke)
Side effects:
1-common: N/V,headache,phototoxcity
2-less common: protenuria,leucopenia

19. Drugs active against cestodes
The 4 important cestodes are:
1-taenia saginata ( beef tapeworm)
2-taenia solium ( pork tapeworm that causes cysticerci in brain and eye)
3-diphyllobothrium latum ( fish tapeworm)
4-echinococcus granulosus (dog tapeworm that cause hydatid cysts in lung,liver,and brain)

20. beef tapeworm
Hydatid cyst in liver

21. Niclosamide Mechanism of action: Act by activating ATPases Uses:
1- 1 of 2 drugs of choice ( with praziquantel) in ttt of fish,pork,and beef tapeworms infection
2-not effective in cycticercosis (albendazole or praziquantel is used)
3- not effective in hydatid disease ( albendazole is used).
Side effects:
Mild GIT upset, rash headache

22. Drug for treatment of nematodes
Infecting organism
Drug of choice
Alternative drug
Ascaris(roundworm)
Albendazole,mebendazole,pyrantel pamoate
piperazine
Ancylostoma(hookworm)
Albendazole,mebendazole,
pyrantel pamoate
Strongyloids stercoralis(threadworm
ivermectin
Enterobius vermicularis(pinworm)
Mebendazole,pyrantel pamoate
albendazole
filariasis
diethylcarbamazine
onchocericasis

23. Drug for treatment of trematodes
Infecting organism
Drug of choice
Alternative drug
s,.haematobium
praziquantel
metrifonate
s.mansoni
oxamniquine
s.japonicum
Fasciola hepatica
bithional
Fasciolopsis buski
Praziquantel or niclosamide

24. Drug for treatment of cestodes
Infecting organism
Drug of choice
Alternative drug
t.Saginata (beef tapeworm)
Praziquantel or niclosamide
mebendazole
t.Solium(pork tapeworm)
Cysticercosis(pork tapeworm larval stage)
albendazole
praziquantel
Diphyllobothrium latium(fish tapeworm)
Hydatid disease

25. Drugs for leishmaniasis
Sodium stibogluconate: for all types of leishmania ( must be given by injection and cardiotoxic)
Alternate drugs:
1-Pentamidine for visceral leishmaniasis
2-Fluconazole or metronidazole for cutaneous lesions
3-Amphotricin B for mucocutaneous lesions

26. ANTIHELMINTHIC DRUGS Therapeutic Strategies
Inhibit muscle contraction
Inhibit energy metabolism
Limit distribution of generally toxic drugs

27. Thank you