ANTI INFECTIVES PHARMACOLOGY

1. ANTI INFECTIVES
syed yousaf shah 1

2. LEARNING OBJECTIVES
syed yousaf shah
2
1. Define the most commonly used drug
category that is used to prevent and treat
infections including antibiotics,
antifungal,antiphrastic, anti malarial and
antiviral drugs.
 2. Briefly discuss action and effects of selected
drug category.
 3. List some of the most commonly used drugs
for each drug category.
 4. Discuss the nursing measures/patient
education which can be taken if patient is using
to treat and prevent infections.

3. INFECTION
syed yousaf shah
3
“Presence of
microorganism inside the
body”

4. syed yousaf shah
4

5. ANTIINFECTIVES
syed yousaf shah
5
“Drugs to kill or retard the
growth of pathogens
without damaging body
tissues”

6. syed yousaf shah
6

7. ANTIBIOTICS
syed yousaf shah
7
Antibiotics are powerful
medicines that fight bacterial
infections.
Used properly, antibiotics can
save lives.
They either kill bacteria or keep
them from reproducing.

8. ANTIBIOTICS
syed yousaf shah
8
 Antibiotics do not fight infections caused
by viruses, such as: - Colds. - Flu. -
Most coughs and bronchitis. - Sore throats,
unless caused by strep.
 If a virus is making you sick, taking antibiotics
may do more harm than good.

9. ANTIBIOTICS
syed yousaf shah
9
 It is important to finish your medicine even if
you feel better.
 Do not save antibiotics for later or use
someone else's prescription.

10. ANTIBIOTICS
syed yousaf shah
10
 Antibiotics normally work by killing the
bacteria that are causing the infection.
The medicine targets the bacteria, leaving
healthy cells alone.

11. ANTIBIOTICS
syed yousaf shah
11
 Using antibiotics correctly can prevent
antibiotic resistance.
 Antibiotic resistance happens when germs get
so strong that they can resist the medicine.

12. GENERAL MECHANISM OF
ACTION OF ANTIINFECTIVES
syed yousaf shah
12
 Interfere with biosynthesis of bacterial cell wall.
 Some inhibit protein synthesis.
 Some change the cell membrane permeability.
 Some inhibit DNA synthesis.

13. SPECTRUM OF ACTIVITY OF
ANTI INFECTIVES
syed yousaf shah
13
 NARROW SPECTRUM ANTIINFECTIVES
E.g. penicillins
 BROAD SPECTRUM ANTI INFECTIVES
E.g. Meropenem

14. How do I take antibiotics?
syed yousaf shah
14
 Doses of antibiotics can be provided in several
ways:
 oral antibiotics – tablets, pills and capsules or a
liquid that you drink.
 topical antibiotics – creams, lotions, sprays or
drops.
 injections of antibiotics – they can be given as
an injection, or an infusion through a drip,
directly into the blood or a muscle.

15. How do I take antibiotics?
syed yousaf shah
15
 How the antibiotic is given will depend on the
type of infection.
 Topical antibiotics are often used to treat skin
infections while oral antibiotics can be used to
treat most types of mild to moderate infections
in the body.
 Antibiotic injections are usually reserved for
more serious infections and are often given in
hospital.

16. How do I take antibiotics?
syed yousaf shah
16
 When treating an infection, physicians may
face a choice between using a bactericidal
(bacteria-killing) drug, a bacteriostatic
(bacteria-inhibiting) drug or a combination
of the two.

17. Types of antibiotics
syed yousaf shah
17
 There are now hundreds of different types of
antibiotics but most of them can be broadly
classified into six groups.
 These are outlined in next slides.

18. PENICILLINS
syed yousaf shah 18

19. Penicillin
syed yousaf shah
19
 Penicillin is widely used to treat certain
infections such as skin infections, chest
infections and urinary tract infections.
 Some widely used types of penicillin include:
 amoxicillin
 flucloxacillin

20. MECHANISM OF ACTION
syed yousaf shah
20
 Binding to PBP  Cell wall
synthesis impairment.
 Production of autolysins.
 Mutation in PBP  Resistance

21. ADVERSE EFFECTS
syed yousaf shah
21
 Mild nausea
 Vomiting
 Diarrhea
 Sore tongue or mouth
 Fever
 Pain at injection site.

22. syed yousaf shah
22
 Around 1 in 15 people will have an allergic reaction
after taking penicillin and a very small number of
people will develop a severe allergic reaction
(anaphylaxis).
 It's important to let your doctor or the health
professional treating you know if you think you may be
allergic to penicillin.
 Another problem with penicillin is that some strains of
bacteria have become resistant to it because it has
been so widely used.

23. CONTRAINDICATION
syed yousaf shah
23
 Hypersensitivity to Penicillins / cephalosporins.

24. PRECAUTIONS
syed yousaf shah
24
 Renal disease
 Pregnancy (Pregnancy Category C)
 Lactation
 Bleeding disorders
 Gastrointestinal disease.

25. syed yousaf shah
25
EDUCATING THE PATIENT AND FAMILY
• Infection—Complete the full course of therapy
• keep an adequate amount of drug in body throughout the entire 24
hours of each day.
• Penicillin (oral)—Take empty stomach
(exceptions: bacampicillin, penicillin V, amoxicillin).
• Take each dose with a full glass of water.
• Oral suspensions—Keep the container refrigerated
• shake the drug well before pouring
• return the drug to the refrigerator immediately after pouring the
dose.
• Discard drug due to losing its potency after 7 – 14 days.

26. CEPHALOSPORINS
syed yousaf shah 26

27. Cephalosporins
syed yousaf shah
27
 Cephalosporins are broad-spectrum antibiotics,
which means they are effective in treating a wide
range of different types of infections including
more serious infections, such as:
 Septicaemia – infection of the blood
 pneumonia
 meningitis – infection of the outer protective layer
of the brain and spinal cord

28. CLASSIFICATION OF
CEPHALOSPORINS
syed yousaf shah
28
1st GENERATION 2ND GENERATION 3RD GENERATION 4TH GENERATION
Cephalaxin Cefoxitin Cefixime Cefepime
Cefadroxil Cefaclor Cefotaxime
Cefazolin Cefamandole Ceftriaxone
Cefuroxime Ceftriaxone
Ceftazidime
Cefoperazone
Ceftizoxime

29. USES
syed yousaf shah
29
 Streptococci, staphlococci, gonococci,
shigella, and clostridia.
 Pharyngitis, tonsillitis, otitis media.
 septicemia, and gonorrhea
 surgical prophylaxis
 infections of the respiratory tract, skin, bone
and joints, urinary tract, brain and spinal cord.

30. MECHANISM OF ACTION
syed yousaf shah
30
 Affect the bacterial cell wall
 Bactericidal
 Same as penicillin.

31. ADVERSE
EFFECTS
syed yousaf shah
31
 Gastrointestinal disturbances.
 Hypersensitivity.

32. syed yousaf shah
32

33. CONTRAINDICATIONS
syed yousaf shah
33
 Hypersensitivity to cephalosporins / penicillins

34. PRECAUTIONS
syed yousaf shah
34
 Use cephalosporins cautiously in renal or
hepatic impairment
 In patients with bleeding disorders.
 In pregnancy or lactation
 Pregnancy Category B.

35. syed yousaf shah
35
EDUCATING THE PATIENT AND
FAMILY
Complete the full course of therapy.
 Do not stop the drug unless directed to do so by the primary health
care provider.
 Take the drug at the prescribed times of day
 Take each dose with food if gastrointestinal upset occurs after
administration.
 Avoid drinking alcoholic beverages when taking the cephalosporins
and for 3 days .
Notify the primary health care provider immediately if any one or more
of the following occurs: vomiting, skin rash, hives (urticaria), severe
diarrhea, vaginal or anal itching, sores in the mouth, swelling around the
mouth or eyes, breathing difficulty or gastrointestinal disturbances, such
as nausea,
vomiting, and diarrhea.
 Do not take the next dose of the drug until the problem is discussed
with the primary health care provider .

36. AMINOG LCOSIDES
syed yousaf shah 36

37. Aminoglycosides
syed yousaf shah
37
 Aminoglycosides are a type of antibiotic that
used to be widely prescribed until it was found
that they could cause both damage to hearing
and the kidneys.
 Because of this, they tend now to be used only
to treat very serious illnesses such
as meningitis.

38. syed yousaf shah
38
 Aminoglycosides break down quickly inside
the digestive system so they have to be given
by injection or as ear or eye drops.
 The most widely used aminoglycoside in
England is called gentamicin.

39. MECHANISM OF ACTION
syed yousaf shah
39
 bactericidal effect
 by blocking a step in protein synthesis
necessary for bacterial multiplication.
 disrupt the functional ability of the bacterial cell
membrane.

40. USES
syed yousaf shah
40
 Against gram-negative microorganisms
 suppressing gastrointestinal bacteria.
 oral aminoglycosides kanamycin and
neomycin  preoperatively to reduce the
number of bacteria normally present in the
intestine
 Oral Kanamycin, neomycin, and paromomycin
 in hepatic coma.

41. ADVERSE EFFECTS
syed yousaf shah
41
 Ototoxicity
 Nephrotoxicity
 Neurotoxicity
 Neuromuscular blockade

42. CONTRAINDICATION
syed yousaf shah
42
 hypersensitivity to aminoglycosides.
 The aminoglycosides
 should not be given to patients requiring
 long-term therapy
 use of streptomycin for long-term management
of tuberculosis.

43. PRECAUTIONS
syed yousaf shah
43
 Renal failure (dosage adjustments may be
necessary)
 Elderly
 Patients with neuromuscular disorders.

44. syed yousaf shah
44
EDUCATING THE PATIENT AND FAMILY
Take the drug at the prescribed time intervals.
These time intervals are important because a certain
amount of the drug must be in the body at all times
for the infection to be controlled.
• Drink six to eight large glasses of fluids while taking
these drugs
• take each dose with a full glass of
water.
• Complete the entire course of treatment.
• Follow the directions supplied with the prescription
regarding taking the drugs with meals or on an
empty stomach. • Avoid any exposure to sunlight or
ultraviolet light
• Avoid tasks requiring mental alertness until

45. Tetracyclines
syed yousaf shah
45
 Tetracyclines are another type of broad-
spectrum antibiotic that can be used to treat a
wide range of infections.
 They are commonly used to treat severe acne
and a condition called rosacea, which causes
flushing of the skin and spots.

46. ACTIONS
syed yousaf shah
46
 Inhibit bacterial protein synthesis.
 Bacteriostatic.

47. USES
syed yousaf shah
47
 Rickettsiae (Rocky Mountain spotted fever,
typhus fever, and tick fevers).
 Tetracycline given when penicillin
contraindicated  treatment of intestinal
amebiasis, skin and soft tissue infections.

48. ADVERSE
EFFECTS
syed yousaf shah
48
 Nausea, vomiting ,Diarrhea , epigastric distress,
stomatitis, and sore throat.
 Skin rashes.

49. CONTRAINDICATION
syed yousaf shah
49
 Hypersensitivity
 Pregnancy category D
 Lactation
 Less than 9 year old children cannot take
tetracyclines.

50. MACROLI
DE
50
syed yousaf shah

51. Macrolides
syed yousaf shah
51
 Macrolides are a type of antibiotic that can be
particularly useful in treating lung and chest
infections.
 They can also be a useful alternative for people
with a penicillin allergy or to treat penicillin-
resistant strains of bacteria.
 Examples of macrolides include:
 erythromycin
 spiramycin

52. ACTIONS
syed yousaf shah
52
 Bacteriostatic or bactericidal.
 Bind to cell membranes and causing changes
in protein function.

53. USES
syed yousaf shah
53
 gram-negative and grampositive
microorganisms.
 treat acne vulgaris and skin infections.

54. ADVERSE EFFECTS
syed yousaf shah
54
 Nausea, vomiting, diarrhea, and abdominal
pain.

55. CONTRAINDICATIONS
syed yousaf shah
55
 Hypersensitivity to macrolide.
 Patients with pre existing liver disease.

56. PRECAUTION
syed yousaf shah
56
 Lactation & pregnancy.

57. syed yousaf shah
57
NURSE ALERT
•Donot give tetracyclines along with dairy
products (milk or cheese), antacids,
laxatives, or products containing iron.
•given 2 hours before or after the
administration
of a tetracycline.
•Food or drugs containing calcium,
magnesium, aluminum, or iron prevent the
absorption of the tetracyclines if ingested

58. EDUCATING THE PATIENTS &
FAMILY
syed yousaf shah
58
 Take the drug at the prescribed time intervals.
 These time intervals are important.
 Do not increase or omit the dose unless
advised to do so by the primary health care
provider.
 Complete the entire course of treatment.

59. FLUOROQUINOLONES
syed yousaf shah 59

60. Fluoroquinolones
syed yousaf shah
60
 Fluoroquinolones are the newest type of
antibiotic.
 They are broad-spectrum antibiotics that can
be used to treat a wide range of infections.

61. MECHANISM OF ACTION
syed yousaf shah
61
 Bactericidal
 by interfering with an enzyme (DNA gyrase)
needed by bacteria for the synthesis of DNA.

62. USES
syed yousaf shah
62
 Gam-positive and gram-negative
microorganisms.
 Treatment of susceptible
Microorganisms in LRTI, skin, urinary tract
infections, and sexually transmitted
diseases.

63. ADVERSE EFFECTS
syed yousaf shah
63
 Hypersensitivity reaction
 nausea, diarrhea,
 headache, abdominal pain or discomfort, and
dizziness.

64. CONTRAINDICATION
syed yousaf shah
64
 Hypersensitivity
 Pregnancy C

65. syed yousaf shah
65
 Examples of fluoroquinolones are:
 ciprofloxacin
 norfloxacin

66. Side effects of Antibiotics
syed yousaf shah
66
 Most antibiotics (with the exception of the
aminoglycosides) don't cause problems for people
who take them and serious side effects are rare.
 The most common reported side effects of
antibiotics are:
 being sick
 feeling sick
 indigestion
 diarrhoea

67. Considerations and interactions
syed yousaf shah
67
 Some antibiotics are not suitable for people
with certain medical conditions, or for women
who are pregnant or breastfeeding.
 You should only ever take antibiotics that are
prescribed to you – never 'borrow' them from a
friend of family member.

68. syed yousaf shah
68
 Some antibiotics can also react unpredictably
with other medications and the oral
contraceptive pill.
 It is therefore important to read the information
leaflet that comes with your medication
carefully.

69. Antibiotic resistance
syed yousaf shah
69
 Both the NHS and health organizations across
the world are trying to reduce the use of
antibiotics, especially for conditions that are
not serious.

70. syed yousaf shah
70
 Strains of bacteria can mutate (change) and, over
time, become resistant to a specific antibiotic.
 The chance of this increases if a person does not
finish the course of antibiotics as some bacteria
may be left to develop resistance.
 Also, antibiotics can destroy many of the harmless
strains of bacteria that live in and on the body.
This allows resistant bacteria to multiply quickly
and replace them.

71. syed yousaf shah
71
 The overuse of antibiotics in recent years has
played a major part in antibiotic resistance.
 This includes using antibiotics to treat minor
conditions that would have got better anyway.

72. Antifungal
syed yousaf shah
72
 Antifungal medicines are used to treat
fungal infections.

73. syed yousaf shah
73

74. syed yousaf shah
74
 Fungi are plant-like organisms that feed by
breaking down living tissue.
 Fungi that cause infections in humans are
known as dermatophytes.

75. syed yousaf shah
75

76. syed yousaf shah
76
 Dermatophytes are particularly attracted to a type
of tissue called keratin, which is a tough,
waterproof tissue found in many parts of the body
such as in the:
 nails
 hair
 skin’s outer surface
 This explains why fungal infections often occur on
the skin, nails and scalp.

77. Common fungal infections
syed yousaf shah
77
 Antifungal medicines may be used to treat the
following common fungal infections:
 Ringworm – which causes a ring-like red rash
on the skin of the body or scalp.
 Athlete’s foot – which affects the skin on the
feet, causing it to become red, flaky and itchy.

78. syed yousaf shah
78
 Fungal nail infection – which causes the
toenails or fingernails to become thickened
and discolored, and sometimes brittle, with
pieces of nail breaking off.
 Vaginal thrush – which causes irritation and
swelling of the vagina and vulva (the
female external sexual organs).

79. Invasive fungal infections
syed yousaf shah
79
 Invasive fungal infections are a less common, but
more serious, type of fungal infection.
 They are infections that occur deep inside the body’s
tissue or in one of the organs, such as in the:
 Brain – for example, fungal meningitis, where a
fungus causes an infection of the protective
membranes that surround the brain and spinal cord.
 Lungs – for example, aspergillosis, which is a lung
infection caused by a fungal mould called aspergillus.

80. syed yousaf shah
80
 People with a weakened immune system (the body’s
natural defence system) are particularly vulnerable to
invasive fungal infections. Those at risk include:
 People with HIV and AIDS.
 People having high-dose chemotherapy to treat
cancer.
 People who are taking immunosuppressant –
medicines to suppress the immune system (the body’s
natural defense against infection and illness), often
used after an organ transplant.

81. syed yousaf shah
81

82. How antifungal medicines work
syed yousaf shah
82
 Antifungal medicines work by either:
 Killing the fungal cells – for example, by
affecting a substance in the cell wall, causing
the contents of the cell to leak out and the cell
to die.
 Preventing the fungal cells from growing and
reproducing.

83. Types of antifungal medicines
syed yousaf shah
83
 Antifungal medicines are used in several ways,
depending on your specific fungal infection. The
main types of antifungal medicines include:
 Topical antifungals, applied to the skin, hair or
nails.
 Oral antifungals, swallowed in capsule, pill or
liquid form.
 Intravenous antifungals, injected into your
bloodstream.

84. syed yousaf shah
84
DRUG USES
Amphotericin B Systemic fungal infections
Fluconazole Oropharyngeal, esophageal,
vaginal candidiasis
Griseofulvin Ring worm infection
Flucytosine Systemic fungal infection
Ketoconazole Fungal infection
Itraconazole Oral; oral / esophageal
candidiasis
Nystatin Nonesophageal membrane GI
candidiasis

85. Things to consider
syed yousaf shah
85
 Before taking antifungal medicines, there are
various things to consider, such as any
existing conditions or allergies that may affect
your treatment for fungal infection.

86. Side effects
syed yousaf shah
86
 As with all medicines, antifungal medicines have side
effects.
 These depend on the type of medication you're taking.
 In most cases, the side effects are mild and only last a
short time, but there are rare cases of more serious
problems.

87. syed yousaf shah
87
 Common side effects include:
 irritation of the skin
 Diarrhoea
 feeling sick
 Indigestion
 In rare cases, liver damage can occur as a result of using
antifungal medicines.

88. ANTIVIRALS
syed yousaf shah 88

89. ACTIONS
syed yousaf shah
89
 Inhibiting viral DNA or RNA replication in the virus 
viral death.

90. USES
syed yousaf shah
90
 Initial and recurrent mucosal and cutaneous
herpes simplex virus (HSV) 1 and 2 infections in
immunocompromised patients, encephalitis, and
herpes zoster.
 HIV (combined with other drugs)
 Cytomegalovirus (CMV).
 Genital herpes
 Influenza A respiratory tract illness

91. COMMON ANTIVIRALS & THEIR
USES
syed yousaf shah
91
DRUG USES
abacavir HIV infection
Amantadine Influenza A, parkinson disease
cidofovir Retinitis of AIDS patient
Delavirdine / amprenavir HIV infection
Famciclovir Acute herpes zoster, HSV 2
Foscarnet CMV retinitis, acyclovir resistant HSV 1 , 2
Ganciclovir CMV retinitis
Lamivudine HIV infection with zidovudine
Oseltamivir Influenza A & B
Penciclovir HSV 1 & 2
Ribavirin LRTI (infants and children)
Zidovudine HIV infection

92. ADVERSE DRUG REACTION OF
SPECIFIC ANTIVIRALS
syed yousaf shah
92
 ACYCLOVIR
 IV administration  phlebitis, lethargy, confusion, tremors, skin
rashes,and nausea.
 Oral adminstration  nausea, vomiting, diarrhea, headache,
dizziness, and skin rashes.
 Topical  transient burning, stinging, and pruritus.

93. syed yousaf shah
93
 AMANTADINE
 GI upset
 nausea and vomiting, anorexia
 asthenia (weakness, loss of strength)
 Constipation.
 depression
 visual disturbances
 Psychosis
 urinary retention
 orthostatic hypotension.

94. syed yousaf shah
94
 RIBAVIRIN
 Worsening of respiratory status
 Hypotension, and ocular irritation.
 Erythema (redness of skin).
 Conjunctivitis , blurred vision.
ZIDOVUDINE
 headache, weakness, malaise, nausea,
abdominal pain,and diarrhea.
 anemia

95. CONTRAINDICATIONS,
PRECAUTIONS, AND
INTERACTIONS
syed yousaf shah
95
 Hypersensitivity to antivirals.
 congestive heart failure, seizures, renal
disease – Contraindications.
 Lactation – Contraindications.
 Renal impairment – caution
 Given in children with caution & during
pregnancy.
 Category X - ribavirin

96. syed yousaf shah
96
DRUG ADMINISTRATION & PATIENT
EDUCATION
ACYCLOVIR
•Topical application should not exceed the frequency prescribed.
•Apply this drug with a finger cot or gloves and cover all lesions.
•Do not have sexual contact while lesions are present.
•Notify the primary health care provider if burning, stinging,
itching, or
rash worsens or becomes pronounced.
• Crystalluria can be prevented
•Administer with food.

97. syed yousaf shah
97
DRUG ADMINISTRATION & PATIENT
EDUCATION
RIBAVIRIN
•drug is given with a small-particle aerosol generator.
•Any worsening of respiratory function, dizziness, confusion, or
shortness of breath should be reported.
•Pregnancy Category X drug and women of childbearing age
should take care not to inhale the drug.
ZIDOVUDINE
•cause dizziness.
•Avoid activities requiring alertness until the drug response is
known.
•Does not prevent transmission to others.
•Notify the primary health care provider if fever, sore throat, or
signs of infection occur.

98. AntipArasItic Drugs
syed yousaf shah
98
 Parasites: Organisms that live within, upon or at
expense of another organism to survive
 Include protozoa, helminths, scabies and pediculi.

99. Protozoa
syed yousaf shah
99
 Include amebiasis, giardiasis, malaria, toxoplasmosis
and trichomoniasis (STD).
 Usually contracted by oral-fecal route, by contaminated
water or by bite of an insect.

100. Amebiasis
syed yousaf shah
100
 Common in Africa, Asia and Latin America.
 In US, more likely in homosexuals and bisexual men
and in those who travel to areas with poor sanitation.

101. syed yousaf shah
101
• Drugs used are classified according to site of
action
• Extra intestinal e.g. liver—use Aralen
(chloroquine)
• For Intestinal :use Yodoxin (lodoquinol)
• Flagyl is effective for intestinal and extra
intestinal amebiasis

102. Giardiasis
syed yousaf shah
102
 Caused by Giardia lamblia
 Spread by food or water contaminated with feces with
encysted forms of organism.
 Also can contract by person to person transmission in
day cares, institutions and in homosexual or bisexual
men.

103. syed yousaf shah
103

104. Helminthiasis
syed yousaf shah
104
 Infestation with parasitic worms.
 Some types of worms penetrate body tissues or produce
larvae that migrate to blood, lymph, lungs, liver or other
sites.
 Some anthelminthics act locally, some systemically.

105. syed yousaf shah
105

106. Vermox (mebendazole)
syed yousaf shah
106
 Effective for hookworms, pinworms, roundworms,
whipworms
 May be useful with tapeworms.
 Prevents uptake of glucose necessary for parasitic
metabolism.
 Only 10% is absorbed systemically.

107. Stromectrol (vermectin)
syed yousaf shah
107
 Used for various parasitic infections, most useful in
stronguloidiasis
 Also used for resistant lice.

108. syed yousaf shah
108

109. Scabies and Pediculosis
syed yousaf shah
109
 Parasitic infestations of the skin.
 Scabies by the itch mite called the Sarcoptes scabeii.
 Scabies caused by one of three types of lice: pediculosis
capitis, pediculosis corporis and pediculosis pubis.

110. syed yousaf shah
110

111. Scabicides and Pediculosis
syed yousaf shah
111
 Ovide (malathion): is a pediculicide for head
lice.
 Rid (pyrethrin): for pediculosis.

112. syed yousaf shah
112

113. Anti Malarial Drugs
syed yousaf shah
113
 The types of drugs and the length of treatment will vary,
depending on:
 Which type of malaria parasite you have
 The severity of your symptoms
 Your age
 Whether you're pregnant

114. syed yousaf shah
114
 The most common antimalarial drugs include:
 Chloroquine (Aralen)
 Quinine sulfate (Qualaquin)
 Hydroxychloroquine (Plaquenil)
 Mefloquine
 Combination of atovaquone and proguanil (Malarone)

115. syed yousaf shah
115
 The history of ant malarial medicine has been marked
by a constant struggle between evolving drug-resistant
parasites and the search for new drug formulations.
 In many parts of the world, for instance, resistance to
chloroquine has rendered the drug ineffective.

116. REFERENCES
syed yousaf shah
116
 1. Applied therapeutics the clinical
use of drugs, 8th edition.
 2. Lipincott, pharmacology.
 3. and dale , pharmacology.
 4. Katzung, book of pharmacology