1. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Chapter 98 Antiprotozoal Drugs II: Miscellaneous Agents

2. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.2 Protozoal Infections  Increasing world travel by Americans  Increased immigration from regions of high infection rates  Increase of protozoal infections in the U.S.  Most frequent  Entamoeba histolytica  Trichomonas vaginalis  Giardia lamblia

3. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.3

4. 4 Protozoal Infections  Amebiasis  Giardiasis  Leishmaniasis  Pneumocystis carinii pneumonia  Toxoplasmosis  Trichomoniasis  American trypanosomiasis (Chagas’ disease)  African trypanosomiasis (sleeping sickness)

5. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.5 Principal Protozoal Infections in the United States  Trichomoniasis  Metronidazole drug of choice  Giardiasis  Metronidazole drug of choice  Amebiasis  Symptomatic or asymptomatic – metronidazole is drug of choice

6. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.6 Drugs of Choice for Protozoal Infections  Iodoquinol  Metronidazole  Tinidazole  Benznidazole  Nitazoxanide  Pentamidine

7. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.7 Drugs of Choice for Protozoal Infections  Suramin  Melarsoprol  Eflornithine  Pyrimethamine  Sodium stibogluconate  Miltefosine  Nifurtimox

8. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.8 Drugs of Choice for Protozoal Infections  Metronidazole (Flagyl, Protostat)  Active against several species  Drug of choice for symptomatic intestinal amebiasis and systemic amebiasis  Adverse effects Nausea, headache, dry mouth, unpleasant metallic taste, and harmless darkening of urine Nausea, headache, dry mouth, unpleasant metallic taste, and harmless darkening of urine If combined with alcohol, may have disulfiram-like actions If combined with alcohol, may have disulfiram-like actions

9. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.9 Drugs of Choice for Protozoal Infections  Suramin  Adverse effects GI effects GI effects Itching, rash Itching, rash Photophobia Photophobia  Melarsoprol  Adverse effects Toxic Toxic Hypertension Hypertension Neuropathy Neuropathy Myocardial damage Myocardial damage