• 400 mg single dose(adults)• 200 mg single dose(1-2 yrs)Round wormsAscaris lumbricoides• 400 mg single dose(adults)• 200 mg single dose(1-2 yrs)Hook wormAncylocystoma duodenaleNecator americanus• 400 mg single dose(adults)• 200 mg single dose(1-2 yrs)Thread wormEnterobius vermicularisAs first choice of drug…
• 400 mg OD x 3 daysWhipwormTrichinella spiralis• 400 mg BD x 8-15 days• Paed. Dose -15 mg/kg/dayTapewormNeurocysticercosis• 400 mg BD x 4 wks• Repeat 2-3 wks if requried• Upto 3 coursesDog tapewormhydatid disease
As Alternative drug…Thread worm-Strongyloides stercoralis400 mg single dose(adults) & 200 mg single dose(1-2 yrs)Whipworm-Trichuris trichura400 mg single dose(adults) & 200 mg single dose(1-2 yrs)FilariasisTapewormTaenia saginata,taenia solium
First benzimidazole polyanthelminticIt inhibits development of eggs of worms & kills larvaeIt has analgesic,antiinflammatory & antipyretic actionMOA-similar as mebendazolePK-well absorbed from GI tractAdv. eff.-nausea,vomiting,loss of appetite,giddiness,itching,abd. pain,diarrhoea
It was introduced for thread worm infestation in children ;use soon extend to roundworm , hook worm. It inactive against trichuris & other worms. Piperazine antagonizes the action of pyrantel Pamoate.Pk - 10-15% of an oral dose is absorbed.Adv. Effects – G.I symptoms, headache,dizziness, tasteless .
Mech. Of ActionContracture & Spastic Paralysis of wormPersistant DepolarizationActivation of nicotinic cholinergic receptors in worm
• Singledose of 10mg/kg isrequiredRound wormAscaris lumbricoides• Singledose of 10mg/kg isrequiredHook wormAncylocstomaduodenale• Singledose of 10mg/kgis requiredThread wormEnterobiusvermicularisAS FIRST CHOICE OF DRUG,
Both are active against many nematodes , but useis restricted to ascariasis & ancylocystomiasis.Mech. Of action Ganglia in worms are stimulated causing tonicparalysis & expulsion of live worms . Interfere with carbohydrate metabolism –inhibition of fumarate reductase also contributing . Nausea, Abd. Pain, gudiness, fatigue .Adv. effects
Uses...As second choice of drug,Round worm – Ascaris lumbricoides• Single dose - 50mg ( C )Hook worm – Ancylocystoma duodenale• Single dose – 150mg ( A )
It is the 1st drug for fillariasis .It highly selective effect on microfilariae .PkWell oral absorptionWidely distributed in the bodyMetabolized in liver & excreted in urinePlasma t½ - 4 -12 hrs
Mech. Of action• Alternation of Mf membranePhagocytosed by tissue fixed monocytes• But not by circulating phagocytes.• Affect muscular activity and causehyperpolarisation due to piperazinemoiety.
Adv. effectsNausea, headache, loss of appetite, weakness,dizziness .Febile reaction with rash, lymphnode enlargement,Bp . leukocytosis , mild albiminuria .
Uses …Filariasis – Wucharia bancrofti• 2mg/kg TDS – Rapid symptomatic ReliefTropical eosinophilia• 2 – 4mg/kg TDS x 2-3 wksLoa loa & o.volvulus – but it give 25-50mg test dose to avoid severereations to dying .
Novel anthelminticActive against Schistosomes ,Trematodes & CestodesMech. Of actionworm loses its grip in git & expelled outContracture & ParalysisActs by causing leakage of IC Ca from the membrane
PK Rapidly absorbed from intestine , T½ - 1.5 hours First pass metabolism , excreted in urine Along with food, absorbtion Enzyme inducers - metabolismAdv. Eff. No systemic toxicity Bitter in taste – nausea & abd. Pain Head ache, dizziness & sedation rashes, urticaria, fever, itching & body painC/I - Occular cysticercosis
USES…. • T.saginata,T.solium-10 mg/kg single dose inmorning• H.nana,D.latum-15-25 mg/kg single dose inmorning• In heavy infestation, retreatment aft. a weekis desirableTapeworm• First to be effective-2nd drug of choice• 50-100 mg/kg daily in 3 doses x 15 daysNeurocysticercosis• 40-75 mg/kg once as single/divideddoseSchistosomes• DOC for fluke infestations except Fasciolahepatica• 75 mg/kg/day x one/two daysOthers flukes
It effective against cestodes infesting man –T.saginata , T.sollium , D.latum , H.nana , threadworm . It safe during pregnancyMech. Of actionCause injury & partly digested in the intestineInterfere with anaerobic generation of ATP by the tapewormInhibit oxydative phosphorylation in mitochondria
Adv. effects Tasteless & non irritating No systemic toxicity Minor abd. Symptoms Malaise, pruritis, light headednessUses As 1st line drug – T.saginata As 2nd line drug – T.sollium
Causative agent: T.solium Due to: migration of larvae from gut to various tissue viablood stream. On anthelmintic treatment ,the larvae dies and itsproduct induce an intense focal reaction results inseizures and other neurological symptoms. Treatment : Albendazole and Praziquantel. Corticosteroids Anti-convulsants.
Advantages of albendazole over praziquantel Short course of treatment High cure rate Corticosteroiods enhances the absorption of albendazole. Albendazole is cheaper.