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12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
12. anti amoebiais
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12. anti amoebiais

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  • Parasite adhere to intestine by lactin proteins. Tropozoites invades the host cell cause cell lysis histolytica
  • Cysts live outside the body at least one week
  • Flatulance excessive gas in stomach & intestine
  • Transcript

    • 1. Intestinal infection - Entamoeba histolytica  Ingested cysts through food water  Poor environmental sanitation  Low socio-economic status  Many patients are asymptomatic  Characterized by diarrhea, weakness 
    • 2. Luminal Phase Cysts in Faeces – propagation of disease.  Tissue phase Ulcer /dysentery Abscess  Extra intestinal Lung, Spleen, Kidney, Brain 
    • 3. Classification  Tissue Amoebicides  Extra intestinal & Intestinal Nitroimidazoles Metronidazole Tinidazole Secnidazole Ornidazole satranidazole Alkaloids Emetine Hydroemetine  Extra intestinal amoebiasis only SHOULD always be followed by Luminal Chloroquine amoebicide to eradicate source of infection
    • 4.  Luminal amoebiasis Amide 8-Hydroxy quinolones Antibiotics Diloxanide furoate Quinidochlor Diiodohydroxyquin Tetracycline
    • 5. Metronidazole Nitroimidazole group, Prototype drug introduced in 1959  It active aganist amoebae, anaerobic bacteria and certain helminthis  PK:- Oral & parental  Absorption occurs in proximal intestine  Well distribution, therapeutic level it found in vaginal, seminal fluid, CSF, saliva and milk  Metabolized by oxidation and glucuronidation  t½-8hrs.  Not given pregnancy 
    • 6. MOA: Enters micro-organism by diffusion PFOR enzyme act as electron removal (Pyruvate ferrodoxin oxido reductase) Nitro group serves as electron acceptor reduced Cyto toxicity DNA Damaged
    • 7. Clinical uses DOC for tissue amoebiasis  Cysts passers Metroindazole + Diloxanide furoate  Moderate intestinal amebiasis 400mg orally TDS 5-7days  Amoebic dysentry , liver abcess 800mg TDS for 7days  Giradiasis- 200mg TDS for 7days  Trichomonas vaginitis -400mgTDS for 7days  Anaerobic bacterial infections brain abscess, endocarditis  Psudomembranous colitis – 500mg TDS  Ulcerative gingivitis, Stomatitis- Metro+ tetracycline  Guinea worm , eradicating H.Pylori 
    • 8. Adverse Drug Reactions  Frequent ○ Anorexia, nausea ○ Metallic taste, abdominal cramps ○ Dark red brown urine • Less frequent ○ Headache, dry mouth, ○ dizziness, rashes ○ neutropenia  On prolonged administration ○ Peripheral neuropathy, CNS effects
    • 9. Contraindications  Neurological diseases, blood dyscrasias,  First trimester, Chronic alcoholism(ADH Inhibition) Drug Interactions      Disulfiram reaction Enzyme inducers - Rifampicin -↓therapeutic effect Cimetidine - ↓metronidazole metabolism reduce dose Metronidazole ↓renal elimination of Lithium Warfarin ↓renal elimination
    • 10. Tinidazole Slower metabolism – longer duration action – Given OD  Better tolerated  Use in amoebiasis – 600mg BD X 7 days  Trichomoniasis, Giardiasis 600mg for 7days Secnidazole – longer duration  2g single dose  Less side effects 
    • 11. Emetine        Alkaloid from Cephaelis ipecacuanha MOA: Protein synthesis inhibitor Potent directly acting amoebicide (trophozoites) Does not kill cysts Toxicity high –Seldom used Reserve drug – not responding/intolerant to metronidazole Luminal amoebicide follows emetine to eradicate cysts Dihydroemetine =effective but less toxic  Preferred over emetine
    • 12. Chloroquine         Kills trophozoites Concentrates in liver Used in hepatic amoebiasis Rx duration longer 500mg x 21days Relapses more frequent than emetine Resistance doesn’t develop Luminal amoebicide must always be given with or after Chloroquine to abolish luminal cycle Dose in liver abcess -600 mg(base) X 2days,300mg X 2-3 weeks Reserved drug only used metronidazole is not tolerated
    • 13. Diloxanide furoate Highly effective luminal amoebicide  Directly kills trophozoites  No anti bacterial action  Drug of Choice for mild intestinal/ asymptomatic amoebiasis  Given after tissue amoebicide to eradicate cysts  Given in combination with metronidazole OR tinidazole  ADRs – pruritis, urticaria, flatulance 
    • 14. 8-hydroxy quinolone Once widely used luminal amoebicide  Rarely now because neuritis & optic damage  Uses: luminal amoebicide, giardiasis  Locally for monilial/trichomonas vaginitis, fungal & bacterial infections  ADR:- green colored stool  Prolong use case iodine overload (Goiter)  Not safer drug for pregnancy and children 
    • 15. Tetracycline  Directly inhibit amoebae but only at high concentration.  ↓bacterial flora  Used along with other luminal agents  Adjuvant in chronic difficult to treat cases
    • 16. GIARDIASIS         Giardia lamblia, Pear shaped Two nuclei and four flagella Attach to intestinal mucosa From they absorb nourishment & interfere absorption Characterized by watery diarrhea & malabsorption Metroindazole 200mg TDS 7days Tinidazole 600mg daily 7days Secnidazole 2g single dose
    • 17. TRICHOMONIASIS  Gential infection produced by Trichomonas vaginalis  Metroindazole 400mg TDS 7days or 2g single dose Tinidazole 600mg daily 7days or 2g single dose Secnidazole 2g single dose Nimorazole 2g single dose with meals    * Repeat course may given after 6 weeks
    • 18. TRYPANANOSOMIASIS Africian Trypnosmiasis :- T. brucei Two stages –  Haemolymphatic – enlargement of lymph node  Meningo encephalopathic – mental distrubance, diziness (Sleeping sickness)  Early- Sumarin or pentmidine  Late CNS – Melarsoprol 
    • 19. American trypanosomiasis(Chagas’ disease)  T.Cruzi Cardiomyopthy  Mega colon- mega esophagus & gastrointestinal lesions Nifurtimox: MOA: free radical generator
    • 20. Toxoplasmosis Toxoplasma gondii  Pyrimethamine+ Clindamycin+ Folinic acid  Pyrimethamine + sulfadiazine 
    • 21. Thank

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