Parasitic infections afflict more than half of the world's population and impose a substantial health burden, particularly in underdeveloped nations, where they are most prevalent. The reach of some parasitic diseases, including malaria, has expanded over the past few decades as a result of factors such as deforestation, population shifts, global warming, and other climatic events. Despite major efforts at vaccine development and vector control, chemotherapy remains the single most effective means of controlling parasitic infections. Efforts to combat the spread of some diseases are hindered by the development and spread of drug resistance, the limited introduction of new antiparasitic agents, and the proliferation of counterfeit medications. However, there are good reasons to be optimistic. The past 10 years have witnessed the launch of ambitious global initiatives aimed at controlling or eliminating threats such as AIDS, tuberculosis, and malaria. Recognition of the substantial burden imposed by the "neglected" tropical diseases has generated multinational partnerships to develop and deploy effective antiparasitic agents. Vaccines against several tropical diseases are being developed, and clinical trials have begun for vaccines against schistosomiasis, hookworm, and leishmaniasis.
This chapter deals exclusively with the agents used to treat infections due to parasites. Specific treatment recommendations for the parasitic diseases of humans are listed in subsequent chapters. The pharmacology of the antiparasitic agents is discussed in great detail in Chap. e26.
Table 208-1 presents a brief overview of each agent (including some drugs that are covered in other chapters), along with its major toxicities, spectrum of activity, and safety for use during pregnancy and lactation. Many of the agents are approved by the U.S. Food and Drug Administration but are considered investigational for the treatment of certain infections; these drugs are marked accordingly in the table. In addition, drugs available only through the Centers for Disease Control and Prevention (CDC) Drug Service (telephone: 404-639-3670 or 404-639-2888; www.cdc.gov/laboratory/drugservice/) or only through their manufacturers (whose contact information may be available from the CDC) are specified by footnotes in the table.
Table 208-1 Overview of Agents Used for the Treatment of Parasitic Infections |Favorite Table|Download (.pdf)
Table 208-1 Overview of Agents Used for the Treatment of Parasitic Infections
|Drugs by Class||Parasitic Infection(s)||Adverse Effects||Major Drug-Drug Interactions||Pregnancy Classa||Breast Milk|
|Amodiaquine||Malariab||Agranulocytosis, hepatotoxicity||No information||Not assigned||No information|
|Chloroquine||Malariab||Occasional: pruritus, nausea, vomiting, headache, hair depigmentation, exfoliative dermatitis, reversible corneal opacity. Rare: irreversible retinal injury, nail discoloration, blood dyscrasias|
Antacids and kaolin: reduced absorption of chloroquine
Ampicillin: bioavailability reduced by chloroquine
Cimetidine: increased serum levels of chloroquine
Cyclosporine: serum levels increased by chloroquine
Frequent: hemolysis in patients with G6PD deficiency.
Occasional: methemoglobinemia, GI disturbances. Rare: CNS symptoms
|Quinacrine: potentiatedtoxicity of primaquine||Contraindicated||No information|
|Tafenoquine||Malariab||Frequent: hemolysis in patients with G6PD deficiency, mild GI upset. Occasional: methemoglobinemia, headaches||No information...|