Antiparasitic Chemotherapy

Chapter 46Chapter 46

Yun-Bi Lu, PhDYun-Bi Lu, PhD卢韵碧卢韵碧

Dept. of Pharmacology, Dept. of Pharmacology, School of Medicine, Zhejiang UniversitySchool of Medicine, Zhejiang University

yunbi@zju.edu.cnyunbi@zju.edu.cn

2014.1.6

Human parasite

• Protozoa （原虫）：孢子虫－疟原虫 鞭毛虫－阴道毛滴虫 叶足虫－阿米巴原虫 纤毛虫－结肠小袋纤毛虫 • Helminth （蠕虫）：吸虫－血吸虫 绦虫－链状带绦虫 线虫－蛔虫、丝虫• Arthropod （节肢动物）：蛛形纲－蜱、螨 昆虫纲－蚊、蝇、虱

1. Anti-malarial drugs (1. Anti-malarial drugs ( 抗疟药抗疟药 ))

2. Anti-amebiasis and anti-trichomoniasis drugs (2. Anti-amebiasis and anti-trichomoniasis drugs ( 抗阿米抗阿米巴病和抗滴虫病药巴病和抗滴虫病药 ))

3. Anti-schistosomiasis and anti-filariasis drugs (3. Anti-schistosomiasis and anti-filariasis drugs ( 抗血吸虫抗血吸虫病和抗丝虫病药病和抗丝虫病药 ))

4. Anthelmintic drugs (4. Anthelmintic drugs ( 抗肠蠕虫药抗肠蠕虫药 ))

ContentsContents

Anti-malarial DrugsAnti-malarial DrugsMalarial parasite (plasmodium, Malarial parasite (plasmodium, 疟原虫疟原虫 ) ) P.falciparum(P.falciparum( 恶性疟原虫恶性疟原虫 )) P.vivax (P.vivax ( 间日疟原虫间日疟原虫 )) P.malariae(P.malariae( 三日疟原虫三日疟原虫 )) P.ovale (P.ovale ( 卵形疟原虫卵形疟原虫 ))

红细胞外期

红细胞内期

按蚊－有性繁殖

人体－无性繁殖

Anti-malarial DrugsAnti-malarial Drugs

1.1. Drugs controlling symptoms Drugs controlling symptoms

-Chloroquine (-Chloroquine ( 氯喹氯喹 ), quinine(), quinine( 奎宁奎宁 ), artemisinin (), artemisinin ( 青蒿青蒿素素 ))

2.2. Drugs controlling relapse and transmissionDrugs controlling relapse and transmission

-primaquine(-primaquine( 伯氨喹伯氨喹 ))

3.3. Drugs for etiological preventionDrugs for etiological prevention

-primethamine(-primethamine( 乙胺嘧啶乙胺嘧啶 ) )

控制复发Primaquine

（伯氨喹） 迟发

病因预防Pyrimethamine

（乙胺嘧啶）速发

控制症状Chloroquine （氯喹）Quinine （奎宁）Mefloquine （甲氟喹）Artemisinin （青蒿素）

阻止传播Pyrimethamine

（乙胺嘧啶）

阻止传播Primaquine （伯氨喹） Chloroquine （氯喹）

Quinine （奎宁）（恶性疟无效）

红细胞外期

红细胞内期

按蚊－有性繁殖

Antimalarial drugsAntimalarial drugs –– Chloroquine Chloroquine （氯喹）（氯喹）

•Chloroquine is a synthetic 4-aminoquinoline derivate Chloroquine is a synthetic 4-aminoquinoline derivate

控制症状Chloroquine 氯喹Quinine 奎宁Mefloquine 甲氟喹Artemisinin 青蒿素

红细胞内期

1. Antimalarial effects1. Antimalarial effects

•Schizonticidal activity (Schizonticidal activity ( 裂殖体杀灭剂裂殖体杀灭剂 )) and and

gametocytocidal (gametocytocidal ( 杀配子体杀配子体 , , but not for P.falciparumbut not for P.falciparum)). .

•The effects are fast and lasting. The effects are fast and lasting.

•The clinical symptoms will vanish after administration oThe clinical symptoms will vanish after administration o

ff

chloroquine in 24-48 h, blood malarial parasiteschloroquine in 24-48 h, blood malarial parasites

disappear in 48-72 h.disappear in 48-72 h.

Antimalarial drugsAntimalarial drugs -- ChloroquineChloroquine

Mechanism of anti-malarial action:Mechanism of anti-malarial action:

1.1. Alkalinization of food vacuoleAlkalinization of food vacuole

2.2. Damage mediated by accumulated heme Damage mediated by accumulated heme

3.3. Decreased DNA synthesisDecreased DNA synthesis

Clinical Uses:Clinical Uses:

1.1. Treatment of malaria: Treatment of malaria:

• Controlling the symptoms of malariaControlling the symptoms of malaria

• Symptomatic prevention in epidemic area. Symptomatic prevention in epidemic area.

• It is not active against exo-erythrocytic form, and shoIt is not active against exo-erythrocytic form, and sho

uld therefore be used with primaquineuld therefore be used with primaquine （（伯氨喹伯氨喹）） to to

effect radical cure of P. vivax effect radical cure of P. vivax (( 间日疟间日疟 )). .

Antimalarial drugsAntimalarial drugs -- ChloroquineChloroquine

Clinical Uses:Clinical Uses:

2. Treatment of amebiasis(2. Treatment of amebiasis( 阿米巴病阿米巴病 ): ):

• treating systemic amebiasis(treating systemic amebiasis( 肠外阿米巴病肠外阿米巴病 ), such as am), such as am

ebic hepatitis(ebic hepatitis( 阿米巴肝炎阿米巴肝炎 ) and amebic hepatic abscess) and amebic hepatic abscess

(( 阿米巴肝脓肿阿米巴肝脓肿 ).).

3.3. ImmunosuppressionImmunosuppression• Treatment of rheumatoid arthritis, lupus erythematosus Treatment of rheumatoid arthritis, lupus erythematosus

Antimalarial drugsAntimalarial drugs -- ChloroquineChloroquine

Adverse Reactions:Adverse Reactions:

1.1. Be less in anti-malarial dose, occasionally dizziness, tinBe less in anti-malarial dose, occasionally dizziness, tinnitus(nitus( 耳鸣耳鸣 ), dysphoria(), dysphoria( 烦躁烦躁 ), skin itching, and GI re), skin itching, and GI reaction.action.

2.2. In high dose, visual disturbance can occurIn high dose, visual disturbance can occur

3.3. Quinidine-like effectsQuinidine-like effects

4.4. Others: aplastic blood and neurological disorders, such Others: aplastic blood and neurological disorders, such as polyneuritis (as polyneuritis ( 多发性神经炎多发性神经炎 ), seizures and neuromy), seizures and neuromyopathy.opathy.

5.5. Teratogenesis(Teratogenesis( 致畸作用致畸作用 ) )

Antimalarial drugsAntimalarial drugs -- ChloroquineChloroquine

控制复发Primaquine

( 伯氨喹 ) 迟发

阻止传播Primaquine ( 伯氨喹 ) Chloroquine ( 氯喹 )

Quinine ( 奎宁 )（恶性疟无效）

红细胞外期

红细胞内期

按蚊－有性繁殖

Antimalarial drugsAntimalarial drugs –– Primaquine Primaquine （伯氨喹）（伯氨喹）

Pharmacological effectsPharmacological effects

•Highly active against the gametocytes (Highly active against the gametocytes ( 配子体配子体 )) oof all malaria species →f all malaria species →dissemination ↓dissemination ↓•Active against hypnozoites (Active against hypnozoites ( 迟发型子孢子迟发型子孢子 ) ) of the of the

relapsing malarial parasitesrelapsing malarial parasites

The only drug currently used for the treatment of reThe only drug currently used for the treatment of relapsing malaria lapsing malaria (( 疟疾复发疟疾复发 ).).

Antimalarial drugsAntimalarial drugs –– Primaquine Primaquine (( 伯氨喹伯氨喹 ))

Mechanism of actionsMechanism of actions•Inhibition of coenzyme Q Inhibition of coenzyme Q •Inhibition of reduction of NADPInhibition of reduction of NADP

Adverse effectsAdverse effects•Transient dizziness , nausea, vomiting, gastTransient dizziness , nausea, vomiting, gast

rointestinal symptomsrointestinal symptoms•Acute hemolytic anemia (Acute hemolytic anemia ( 急性溶血性贫急性溶血性贫

血血 ), methemoglobinemia (), methemoglobinemia ( 高铁血红蛋白血高铁血红蛋白血症症 ))

Antimalarial drugsAntimalarial drugs –– Primaquine Primaquine （伯氨喹）（伯氨喹）

红细胞外期

红细胞内期

按蚊－有性繁殖

Antimalarial drugsAntimalarial drugs –– Pyrimethamine Pyrimethamine （（乙胺嘧啶乙胺嘧啶））

病因预防Pyrimethamine( 乙胺嘧啶 ) 速发

Pyrimethamine( 乙胺嘧啶 )

Pharmacological effectsPharmacological effects•Inhibition of proliferation of sporozoite Inhibition of proliferation of sporozoite (( 子孢子子孢子 )) t t

o schizont o schizont (( 裂殖体裂殖体 ))•Prophylaxis of infectionsProphylaxis of infections

Mechanism of actionsMechanism of actions•Dihydrofolate reductase inhibitorDihydrofolate reductase inhibitor

Adverse effectsAdverse effects•Folate metabolism disturbtanceFolate metabolism disturbtance

Antimalarial drugsAntimalarial drugs –– Pyrimethamine Pyrimethamine （乙胺嘧啶）（乙胺嘧啶）

• 用于控制症状的抗疟药 Chloroquine Chloroquine （氯喹）（氯喹）、 Quinine Quinine （奎宁）、（奎宁）、 Mefloquine Mefloquine （甲氟喹）、（甲氟喹）、 Pyronaridine (Pyronaridine ( 咯萘咯萘

啶啶 )) 、、 Artemisinin (Artemisinin ( 青蒿素青蒿素 ) ) 、、 Artemether and artesunate (Artemether and artesunate ( 蒿甲醚和青蒿琥蒿甲醚和青蒿琥

酯酯 ) )

• 用于控制复发和传播的抗疟药 Primaquine Primaquine （伯氨喹）（伯氨喹）• 用于病因性预防的抗疟药 Pyrimethamine Pyrimethamine （乙胺嘧啶）（乙胺嘧啶）

symptomsymptom ？？

复发？复发？

传播？传播？

控制症状Chloroquine （氯喹）Quinine （奎宁）Mefloquine （甲氟喹）Artemisinin （青蒿素）

病因预防？病因预防？控制复发

Primaquine（伯氨喹） 迟发

阻止传播Primaquine （伯氨喹） Chloroquine （氯喹）

Quinine （奎宁）（恶性疟无效）

病因预防Pyrimethamine( 乙胺嘧啶 ) 速发

阻止传播Pyrimethamine

（乙胺嘧啶）

Selection of antimalarial drugsSelection of antimalarial drugs

1.1. Symptom control: Chloroquine;Symptom control: Chloroquine;

2.2. Cerebral malaria: Artemisinin, im. Cerebral malaria: Artemisinin, im.

Quinine dihydrochloride, iv Quinine dihydrochloride, iv

3.3. Chloroquine-resistant subtertian malaria: Chloroquine-resistant subtertian malaria:

Quinine, Artemisinin. Quinine, Artemisinin.

4.4. Resting stage: Pyrimethamine+ PrimaquineResting stage: Pyrimethamine+ Primaquine

5.5. Prevent transmission: PyrimethaminePrevent transmission: Pyrimethamine

Combined administrationCombined administration

1.1. Chloroquine+ PrimaquineChloroquine+ Primaquine

2.2. Pyrimethamine+ PrimaquinePyrimethamine+ Primaquine

Antimalarial drugs –Antimalarial drugs – SummarySummary

Amebiasis is infection with Entamoeba histolytica,Amebiasis is infection with Entamoeba histolytica, A tiny, one-celled organism. A tiny, one-celled organism.

Antiamebiasis drugsAntiamebiasis drugs -Amebiasis-Amebiasis

Intestinal AmebiasisIntestinal Amebiasis

Extraintestinal AmebiasisExtraintestinal Amebiasis

Features of AmebiasisFeatures of Amebiasis

1. Luminal amebiasis(1. Luminal amebiasis( 肠内感染肠内感染 ):): Amebic dysentery( Amebic dysentery( 阿米巴痢疾阿米巴痢疾 )) Asyptomatic passers( Asyptomatic passers( 无症状带虫者无症状带虫者 ))

2. Systemic amebiasis(2. Systemic amebiasis( 肠外感染肠外感染 ):):

Amebic hepatitis(Amebic hepatitis( 阿米巴肝炎阿米巴肝炎 ) &) &

Hepatic abscess (Hepatic abscess ( 阿米巴肝脓肿阿米巴肝脓肿 ) , etc.) , etc. 　　 3. Mixed amebiasis3. Mixed amebiasis

Classification of amebiasisClassification of amebiasis

1.1. Metronidazole(Metronidazole( 甲硝唑甲硝唑 ););

2.2. Emetine(Emetine( 依米丁依米丁 ) & Dehydroemetine() & Dehydroemetine( 去氢依米丁去氢依米丁 ););

3.3. Diloxannide(Diloxannide( 二氯尼特二氯尼特 ); );

4.4. Paromomycin(Paromomycin( 巴龙霉素巴龙霉素 ); );

5.5. Chlorpromaquin(Chlorpromaquin( 氯喹氯喹 ), etc. ), etc.

Anti-amebiasis drugs (amebicides)Anti-amebiasis drugs (amebicides)

Antiamebiasis drugsAntiamebiasis drugs -- Metronidazole Metronidazole 甲硝唑甲硝唑

Pharmacological effectsPharmacological effects

1. Anti-ameba effects 1. Anti-ameba effects (( 肠内、肠外肠内、肠外 )) The treatment of all tissue infections with E histolyticaThe treatment of all tissue infections with E histolytica2. Anti-trichomoniasis (2. Anti-trichomoniasis ( 抗滴虫抗滴虫 ))3. Anti-anaerobic bacteria infection3. Anti-anaerobic bacteria infection All anaerobic cocci All anaerobic cocci (( 所有的厌氧球菌所有的厌氧球菌 ););

G- anaerobic bacillus G- anaerobic bacillus (( 厌氧杆菌厌氧杆菌 );); G+ spore anaerobic bacillus G+ spore anaerobic bacillus (( 芽孢厌氧杆菌芽孢厌氧杆菌 ););4. Anti-giardia lamblia 4. Anti-giardia lamblia (( 贾第氏鞭毛虫贾第氏鞭毛虫 ))effecteffect

Mechanism of actionsMechanism of actions

•The methyl group of metronidazole is chemicallThe methyl group of metronidazole is chemically reduced in anaerobic bacteria and sensitive protoy reduced in anaerobic bacteria and sensitive protozoans. zoans.

•Reactive reduction products appear to be respoReactive reduction products appear to be responsible for antimicrobial activity.nsible for antimicrobial activity.

•Rapidly absorbed and has a bioavailability of approximRapidly absorbed and has a bioavailability of approximately 90% ately 90%

Antiamebiasis drugsAntiamebiasis drugs - - MetronidazoleMetronidazole

Adverse effectsAdverse effects

•Minor side effectsMinor side effects ：： nausea, headaches, loss of anausea, headaches, loss of appetite, a metallic taste, and rarely a rash.ppetite, a metallic taste, and rarely a rash.

•Serious side effectsSerious side effects ：： seizures and damage of nerseizures and damage of nerves resulting in numbness and tingling of extremities ves resulting in numbness and tingling of extremities (( 肢体麻木肢体麻木，， peripheral neuropathy).peripheral neuropathy).

•TeratogenesisTeratogenesis

Antiamebiasis drugsAntiamebiasis drugs - - MetronidazoleMetronidazole

Amebicide effects:Amebicide effects: killkill trophozoite trophozoite (( 滋养体滋养体 ))

Mechanism of actions:Mechanism of actions: protein synthesis inhibitor.protein synthesis inhibitor.

Clinic uses: Clinic uses:

•Amebic liver abscess , Acute amebic Amebic liver abscess , Acute amebic dysenterydysentery(( 痢疾痢疾))•Used in case of resistance to metronidazole.Used in case of resistance to metronidazole.

EmetineEmetine 依米丁依米丁 & dehydroemetine& dehydroemetine 去氢依米丁去氢依米丁

EmetineEmetine 依米丁依米丁 & dehydroemetine& dehydroemetine 去氢依米丁去氢依米丁

Adverse effectsAdverse effects

•GI effect:GI effect: Nausea, vomiting and diarrhoea. Nausea, vomiting and diarrhoea.

•Cardiac toxicity:Cardiac toxicity: Palpitations, tachycardia, retros Palpitations, tachycardia, retrosternal pain, hypotension, dyspnoea, ECG changes (Sternal pain, hypotension, dyspnoea, ECG changes (ST depression, QT prolongation, T-wave inversion). T depression, QT prolongation, T-wave inversion).

•Neuromuscular blockade: Neuromuscular blockade: Tremor, myasthenia anTremor, myasthenia and paralysis including respiratory paralysis.d paralysis including respiratory paralysis.

•Injection site effectInjection site effect

Antiamebiasis drugsAntiamebiasis drugs - - Other amebicidesOther amebicides

Diloxanide Diloxanide 二氯尼特二氯尼特persons infected with asymptomatic amebiasis persons infected with asymptomatic amebiasis (( 无症状的阿米巴病无症状的阿米巴病 )) . .

Paromomycin Paromomycin 巴龙霉素巴龙霉素Acute amebic dysentery (Acute amebic dysentery ( 痢疾痢疾 ))

Chloroquine Chloroquine 氯喹氯喹Extraintestinal amebiasisExtraintestinal amebiasis

Antiamebiasis drugsAntiamebiasis drugs

Persons infected with asymptomatic amebiasisPersons infected with asymptomatic amebiasis (( 无症状的阿米巴病无症状的阿米巴病 ):):

Diloxanide Diloxanide 二氯尼特二氯尼特 , , ParomomycinParomomycin 巴龙霉巴龙霉素素

Amebic dysenteryAmebic dysentery (( 痢疾痢疾 ): ):

Metronidazole Metronidazole 甲硝唑甲硝唑 + Diloxanide + Diloxanide

MetronidazoleMetronidazole 甲硝唑 甲硝唑 + Paromomycin + Paromomycin

Extraintestinal amebiasis: Extraintestinal amebiasis:

Metronidazole Metronidazole 甲硝唑甲硝唑 + Diloxanide + Diloxanide

Metronidazole (Metronidazole ( 甲硝唑甲硝唑 )) The most effective drug to treat the infection of TrichThe most effective drug to treat the infection of Trich

omonas vaginalis. omonas vaginalis.

Acetarsol (Acetarsol ( 乙酰胂胺乙酰胂胺 )) Preparation of five-valence arsine and can kill TrichoPreparation of five-valence arsine and can kill Tricho

monas vaginalis directly. monas vaginalis directly.

Anti-trichomoniasis drugs Anti-trichomoniasis drugs (Trichomonacides)(Trichomonacides)

BilharziasisBilharziasis急性•发热•过敏反应•腹痛、腹泻•肝脾肿大

Anti-bilharziasis (Anti-bilharziasis ( 血吸虫血吸虫 ) & filariasis () & filariasis ( 丝虫丝虫 ) Dr) Drugug

Anthelmintic Actions (Anthelmintic Actions ( 驱虫作用驱虫作用 ))

•Schistosomiasis (Schistosomiasis ( 血吸虫病血吸虫病 ))•Clonorchiasis, Opisthorchiasis (Clonorchiasis, Opisthorchiasis ( 支睾吸虫病支睾吸虫病 ), ), Paragonimiasis (Paragonimiasis ( 肺吸虫病肺吸虫病 ))•Taeniasis (Taeniasis ( 绦虫病绦虫病 )) 、、 Diphyllobothriasis (Diphyllobothriasis ( 裂头绦裂头绦

虫病）虫病）H Nana (H Nana ( 缩小膜壳绦虫缩小膜壳绦虫 ))•Neurocysticercosis (Neurocysticercosis ( 脑囊虫病脑囊虫病 ))•Hydatid Disease (Hydatid Disease ( 包虫病包虫病 ))•OthersOthers ： ： fasciolopsiasis(fasciolopsiasis( 布氏姜片虫病布氏姜片虫病 ), ), metagonimiasis(metagonimiasis( 后殖吸虫病后殖吸虫病 ))heterophyiasis(heterophyiasis( 异形吸虫病异形吸虫病 ))Fascioliasis(Fascioliasis( 片形吸虫病片形吸虫病 ))

PraziquantelPraziquantel 吡喹酮

Mechanism of actionsMechanism of actions

Mechanism of anti-Schistosoma action: Mechanism of anti-Schistosoma action: • Increase the membrane permeability for certain monovalent Increase the membrane permeability for certain monovalent

& divalent cation, particular Ca2+, and cause Schistosoma mu& divalent cation, particular Ca2+, and cause Schistosoma mu

scular contraction and spastic paralysis.scular contraction and spastic paralysis.• Damage the epidermis of schistosoma.Damage the epidermis of schistosoma.

PraziquantelPraziquantel 吡喹酮

Mechanism of Praziquantel anti-Schistosoma action.

Adverse reactions:Adverse reactions:

•Abdominal pain, nausea, dizziness, and Abdominal pain, nausea, dizziness, and

headache in short-termheadache in short-term

•Hypersensitive effectsHypersensitive effects

PraziquantelPraziquantel 吡喹酮

Anti-filariasis drug - Diethylcarbamazine Anti-filariasis drug - Diethylcarbamazine 乙胺嗪乙胺嗪

FilariasisFilariasis• 淋巴管炎、淋巴

结炎• 橡皮肿、乳糜尿

    Diethylcarbamazine (Diethylcarbamazine ( 乙胺嗪乙胺嗪 , Hetrazan, , Hetrazan, 海群生海群生 ))

Anti-filaria effects:Anti-filaria effects:

• Destroying the epidermis of microfilaremia(Destroying the epidermis of microfilaremia( 微丝蚴微丝蚴 ) of B) of Brugia malayi’s filaria(rugia malayi’s filaria( 马来丝虫马来丝虫 ) & Bancroft’s filaria() & Bancroft’s filaria( 班班氏丝虫氏丝虫 ).).

• The large dose of hetrazan can act on imago(The large dose of hetrazan can act on imago( 成虫成虫 ) in lym) in lymphatic system too.phatic system too.

Adverse reactions:Adverse reactions: GI reaction, such as anorexia, nausea, vomit, and headachGI reaction, such as anorexia, nausea, vomit, and headach

e, asthenia(e, asthenia( 乏力乏力 ),etc.),etc. Anaphylaxis caused by alloprotein of died microfilaremiaAnaphylaxis caused by alloprotein of died microfilaremia

(( 微丝蚴微丝蚴 ).). Lymphadenectasis(Lymphadenectasis( 淋巴结肿大淋巴结肿大 ) caused by died imago) caused by died imago

(( 成虫成虫 ).).

AlbendazoleAlbendazole

(( 阿苯达唑阿苯达唑 , “, “ 肠虫清”肠虫清” ))

Anthelmintic activity:Anthelmintic activity:

• Intestinal parasitosis(Intestinal parasitosis( 肠寄生虫病肠寄生虫病 ):):

• Broad spectrum & high potency: Broad spectrum & high potency:

Anthelmintic DrugsAnthelmintic Drugs驱 ( 蠕 ) 虫药

1)1) Nematoindea(Nematoindea( 线虫线虫 ):): e.g. ascaris( e.g. ascaris( 蛔虫蛔虫 ), hookworm), hookworm

(( 钩虫钩虫 ), pinworm(), pinworm( 蛲虫蛲虫 ), whipworm (), whipworm ( 鞭虫鞭虫 ); );

2)2) Tapeworm(Tapeworm( 绦虫绦虫 ):): pork t.( pork t.( 猪肉绦虫猪肉绦虫 ), beef t.(), beef t.( 牛肉绦牛肉绦虫虫 ). ).

3)3) Exo-intestinal parasitosis(Exo-intestinal parasitosis( 肠外寄生虫病肠外寄生虫病 ):): hydatidosishydatidosis

(( 包虫病包虫病 ), cysticercosis(), cysticercosis( 囊虫病囊虫病 ), trichinosis(), trichinosis( 旋毛虫旋毛虫病病 ), clonorchiasis(), clonorchiasis( 华支睾吸虫华支睾吸虫 ), paragonimiasis(), paragonimiasis( 肺吸肺吸虫病虫病 ), ang hydatidocystis(), ang hydatidocystis( 棘球幼囊棘球幼囊 ).).

Anthelmintic drugs-Anthelmintic drugs-Albendazole (Albendazole ( 阿苯达唑阿苯达唑 ))

Clinical Uses:Clinical Uses:

1.1. Intestinal nematodiasis (Intestinal nematodiasis ( 肠线虫病肠线虫病 ))

2.2. Intestinal taeniasis (Intestinal taeniasis ( 肠绦虫病肠绦虫病 ))

3.3. Cysticercosis (Cysticercosis ( 囊虫病囊虫病 ))

4.4. Hydatidosis (Hydatidosis ( 包虫病包虫病 , , 细粒棘球蚴病细粒棘球蚴病 ))

5.5. Clonorchiasis (Clonorchiasis ( 华支睾吸虫病华支睾吸虫病 ))

6.6. Trichinosis (Trichinosis ( 旋毛虫病旋毛虫病 ))

7.7. Paragonimiasis (Paragonimiasis ( 肺吸虫病肺吸虫病 ))

Anthelmintic drugs - Anthelmintic drugs - AlbendazoleAlbendazole (( 阿苯达阿苯达唑唑 ))

Adverse reactions:Adverse reactions:

• Less when treating intestinal parasitosis Less when treating intestinal parasitosis

• More sever when treating exo-intestinal parasiMore sever when treating exo-intestinal parasitosis (because of larger dose & longer treatmentosis (because of larger dose & longer treatment course) t course)

• Anaphylaxis: headache, fever, skin rash & musAnaphylaxis: headache, fever, skin rash & muscular aching pain, etc. cular aching pain, etc.

• teratogenesis(teratogenesis( 致畸致畸 ) and embryotoxicity() and embryotoxicity( 胚胎胚胎毒性毒性 ). ).

Anthelmintic drugs - Anthelmintic drugs - Albendazole (Albendazole ( 阿苯达阿苯达唑唑 ))

• synthetic benzimidazole that has a wide spectrum synthetic benzimidazole that has a wide spectrum of anthelmintic activityof anthelmintic activity

Anthelmintic DrugsAnthelmintic Drugs – – MebendazoleMebendazole （甲苯达唑）（甲苯达唑）

1.1. Piperazine Piperazine （（哌嗪）哌嗪） :: 蛔虫、绦虫蛔虫、绦虫

2.2. Levamisole Levamisole （（左旋咪唑）：蛔虫、钩虫、绦虫左旋咪唑）：蛔虫、钩虫、绦虫

3.3. Pyrantel Pyrantel （（噻嘧啶）：蛔虫、钩虫、绦虫噻嘧啶）：蛔虫、钩虫、绦虫

4.4. Niclosamide Niclosamide （（氯硝柳胺）：绦虫氯硝柳胺）：绦虫

5.5. Praziquantel Praziquantel （（吡喹酮）：吸虫、绦虫吡喹酮）：吸虫、绦虫

Anthelmintic DrugsAnthelmintic Drugs - - Other Anthelmintic DrugsOther Anthelmintic Drugs

Anthelmintic Drugs –Anthelmintic Drugs – SummarySummary

Therapiutic drugsTherapiutic drugs

蛔虫感染蛔虫感染 Mebendazole, Albendazole,Pyrantel, PiperazineMebendazole, Albendazole,Pyrantel, Piperazine

蛲虫感染蛲虫感染 Mebendazole, Albendazole, PyrantelMebendazole, Albendazole, Pyrantel

钩虫感染钩虫感染 Mebendazole, Albendazole, PyrantelMebendazole, Albendazole, Pyrantel

鞭虫感染鞭虫感染 MebendazoleMebendazole

绦虫感染绦虫感染 Praziquantel, Niclosamide, Praziquantel, Niclosamide,

囊虫病囊虫病 Praziquantel, AlbendazolePraziquantel, Albendazole

包虫病包虫病 Albendazole, Praziquantel, Mebendazole Albendazole, Praziquantel, Mebendazole

Thanks !