PRESENTED BY: Group 8 (PRIST) Sneha Kulkarni Vinita Pillai Snehal Khedekar Urvashi Rajput Vijay...
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Transcript of PRESENTED BY: Group 8 (PRIST) Sneha Kulkarni Vinita Pillai Snehal Khedekar Urvashi Rajput Vijay...
ANTIAMOEBIC DRUGS
PRESENTED BY: Group 8
(PRIST)Sneha Kulkarni
Vinita PillaiSnehal KhedekarUrvashi RajputVijay Bansode
Amoebiasis
Amoebiasis is an infection of the intestine, liver, or other tissues caused by a one-celled parasite called Entamoeba histolytica.
Amoebiasis is most prevalent in tropical and subtropical countries
Poverty, ignorance, overcrowding, poor sanitation and malnutrition favour transmission
It is acquired by ingesting food or water contaminated by infected feces.
Symptoms Mostly they are quite mild and can include
loose stools stomach pain abdominal cramps
Amoebic dysentery – severe form stomach pain bloody stools fever jaundice anorexia weight loss
Rarely the parasite invades liver and forms an abscess and spread to other parts of the body, such as lungs or brain
Diagnosis of Amoebiasis
Medical history, physical examination, lab tests and stool examination
Blood test to reveal antibodies against the organism
Sigmoidoscopy to evaluate the intestinal wall
Radiological studies including ultrasound and CT scans to detect liver abscesses
Treatment of Amoebiasis
The choice of drug depends on the severity of the symptom
Drugs include Metronidazole Emetine Chloroquine Diloxanide furoate 8 - hydroxyquinoline Tetracycline
Classification Tissue amoebicides
For both intestinal and extra intestinal amoebiasis:▪ Nitroimidazoles: Metronidazole, Tinidazole,
Secnidazole, Ornidazole, Satranidazole.▪ Alkaloids: Emetine, Dehydroemetine
For extraintestinal amoebiasis only:▪ Chloroquine
Luminal amoebicides Amide: Diloxanide furoate 8-Hydroxyquinolines: Quiniodochlor,
Diiodohydroxyquin Antibiotics: Tetracycline
Metronidazole Prototype nitromidazole.(1959) Highly active amoebicide. Broad spectrum cidal activity against protozoa. It is selectively toxic to anaerobic microorganism.
MOA Nitro group is reduced to highly reactive nitro radical that
causes damage to DNA and other critical biomolecules by cytotoxicity
It disrupts energy metabolism DNA helix destabilization and strand breakage are
observed Found to inhibit cell mediated immunity to induce
mutagenesis and to cause radiosensitization
Pharmacokinetics Completely absorbed from small intestine Metabolized in liver by oxidation and glucoronide
conjucation Excreted in urine Plasma t1/2 is 8hrs
ADR Frequent- Anorexia, Nausea, Metallic taste, Abdominal
cramps Less frequent-Headache, Glossitis, Dizziness, Rashes Peripheral neuropathy and CNS effects Seizures Thromboflebitis
Uses Amoebiasis
Giardiasis
Trichomonas vaginitis
Anaerobic bacterial infections
Pseudo membranous enter colitis
Ulcerative gingivitis, trench mouth
Peptic ulcer
Tinidazole Equally efficacious as metronidazole Metabolism is slower, t1/2 approx.12hrs Better tolerated Lower incidence of side effects ADRs- Nausea, Rash, Metallic taste
Secnidazole Congener of metranidazole Same spectrum of activity and potency Absorption rapid after oral administration Slow metabolism (17-29hrs)
Ornidazole Activity similar to metronidazole Slowly metabolized (12-14hrs) Dose and duration resemble those for Tinidazole Side effect profile is also similar
Satranidazole Longer t1/2 (14hrs) Better tolerability No nausea, vomiting or metallic taste, absence of
neurological diseases
Contradictions
Neurological diseases
Blood dyscrasia
First trimester of pregnancy
Chronic alcoholism
EMETINE
MOA:
Alkaloid from Cephalis ipecacuanha.
Potent directly acting amoebicide (trophozoites).
Does not kill cysts.
Inhibiting protein synthesis in amoebae.
Cannot given orally, administered by s.c or i.m injection.
ADR:
Cumulative toxicity high
It is an irritant; pain, stiffness, eczematous lession at site of injection.
Nausea and vomiting, abdominal cramp and diarrhoea, Weakness and stiffness of muscle
Hypotension, tachycardia, ECG change, mayocarditis.
Contraindicated in presence of cardiac or renal disease and during pregnancy.
USES:
Seldom used as Reserve drug in intestinal and extra intestinal amoebiasis
Patients not responding / intolerant to metronidazole.
Luminal amoebicide follows emetine to eradicate cysts.
Also effective in liver fluke infestation.
Dihydroemetin = effective but less toxic.
Preferred over emetine.
ChloroquineMOA
By accumulating in the acidic vesicle of amoeba it raises the vesicular PH interfere with degradation of haemeoglobin by parasitic lyzosomes.
PHARMACOKINETICS
Oral absorbtion Have the high affinity for melanin and nuclear chromatin Partly metabolised in liver 50% bound in the plasma
Side effects
Anorexia Epigastric pain Loss of vision due to retinal damage Loss of hearing Mental disturbance
Uses
Rhematoid arthritis Lepra reaction Photogenic reaction
Diloxanide furoate
MOA
Luminal amoebicidal Furoate ester hydrolysed in intestine Then released diloxanide which gets largely absorbed Diloxanide is weaker amoebicide than furoate ester.
Pharmacokinetics
Its is metabolised by glucoronidation. Excreted in urine.
Uses
Mild intestinal/asymptomatic amoebiasis
Combined with metroniadazole or tinidazole.
ADR
Occasional nausea
Itching
Rarely urticaria
8-Hydroxyquinolines
Widely employed in past. MOA Active against ENTAMOEBA Kill cyst forming tropozoids in intestine Eradicate cyst from asymptomatic carrier
PHARMACOKINETIC Absorption from intestine (10-30%) Absorbed fraction conjugate in liver with glucoronic acid. Excreted in urine. ½ life is 12 hour.
Uses
Giardiasis Trichomonas Vaginitis Non specific diarrhoea Dietry indiscretion. Fungal and bacterial skin infection
ADR
SMON-sub acute myelo optic neuropathy in Japan Goitre Transient loose and green stool
TETRACYCLINE Directly Inhibit amoebae at high concentration. Older tetracycline is incompletely absorbed in the small
intestine which reaches colon and inhibits bacterial flora along with Entamoeba living symbiotically.
USES: It is adjuvant in chronic, difficult to treat cases Tetracycline lessen risk of opportunistic infection,
perforation, peritonitis. When given along with systemic amoebicide. Not good for acute dysentery and for hepatic
amoebiasis.
RECENT RESEARCH
This review compares different drugs used against amoebic colitis, alone or in combination, and also assesses single-dose regimens versus longer regimens.
Thirty-seven trials with 4487 participants were included, and only one was of high methodological quality. Tinidazole reduced clinical failure compared with metronidazole and was associated with fewer adverse events. Combination therapy resulted in fewer parasitological failures than metronidazole alone.
Tinidazole appears more effective at reducing clinical failures than metronidazole and has fewer associated adverse events. There is insufficient evidence to draw conclusions regarding the efficacy of the other antiamoebic drugs. The choice of antiamoebic drugs would depend largely on the availability and accessibility of drugs.
Drugs for treating amoebic colitis
References Essential of medical pharmacology
by K. D. Tripathi
http://www.2.cochrone.org/review/en/ab006085.html Journal of Ethano pharmacology
http://www.medlineplus.com/
http://www.drugs.com/multimedia/pdfs.pdf