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. Ambitious global initiatives aimed at controlling or eliminating threats such as AIDS, tuberculosis, and malaria have demonstrated some early successes. 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 for vaccines against parasites continue.
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. Many of the agents discussed herein are approved by the U.S. Food and Drug Administration (FDA) but are considered investigational for the treatment of certain infections. Drugs marked in the text with an asterisk (*) are available through the Centers for Disease Control and Prevention (CDC) Drug Service (telephone: 404-639-3670 or 404-639-2888; www.cdc.gov/ncpdcid/dsr/). Drugs marked with a dagger (†) are available only through their manufacturers; contact information for these manufacturers may be available from the CDC.
Table 121-1 presents a brief overview of each agent (including some drugs that are covered in other chapters), along with major toxicities, spectrum of activity, and safety for use during pregnancy and lactation.
TABLE 121-1OVERVIEW OF AGENTS USED FOR THE TREATMENT OF PARASITIC INFECTIONS ||Download (.pdf) TABLE 121-1 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 |
|4-Aminoquinolines || || || || || |
| 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
|Not assignedc ||Yes |
|8-Aminoquinolines || || || || || |
| Primaquine ||Malariab ||Frequent: hemolysis in patients with G6PD deficiency ||Quinacrine: potentiated toxicity of primaquine ||Contraindicated ||No information |
| || ||Occasional: methemoglobinemia, GI disturbances. Rare: CNS symptoms || || || |
| Tafenoquine ||Malariab ||Frequent: hemolysis in patients with G6PD deficiency, mild GI upset. Occasional: methemoglobinemia, headaches ||No information ||Not assigned ||No information |
|Aminoalcohols || || || || || |
| Halofantrine ||Malariab ||Frequent: abdominal pain, diarrhea. Occasional: ECG disturbances (dose-related ...|