Antiparasitic Agents

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Abstract

A number of effective antiprotozoal and anthelmintic drugs are currently available. Antiparasitic agents are important both for therapy of infected individual patients and for control of parasitic infections at the community level. Large-scale chemotherapy is reducing transmission, morbidity, and mortality of certain infections, including lymphatic filariasis, onchocerciasis, schistosomiasis, and infections with intestinal nematodes. However, the lack of financial incentives to develop new agents is a major limitation to the future of antiparasitic chemotherapy. Emerging resistance among parasites, lack of effective antiparasitic vaccines, and the enormous burden of disease worldwide also pose challenges to the effective management of parasitic infections. This chapter focuses on the mechanisms of action, pharmacology, clinical utility, and adverse effects of common first-line antiparasitic therapies and newer drug alternatives. Most helminth infections in humans can be treated with one of five drugs, namely, albendazole, mebendazole, praziquantel, ivermectin, and diethylcarbamazine (DEC), so these five drugs are reviewed in detail. Another agent, nitazoxanide, has both anthelmintic and antiprotozoal activity and is also discussed. Other major antiprotozoal drugs are also reviewed, including those used for malaria, infections with gastrointestinal protozoa, leishmaniasis, and trypanosomiasis, but an exhaustive list of all antiparasitic drugs is not included. Specifically, we exclude discussion of agents without a first-line indication or that are recommended only in special situations, such as furazolidone in children. Tribendimidine is a promising new agent for treatment of liver flukes (clonorchiasis and opisthorchiasis), but trials are still under way, and it has not yet been approved for use, so it is not discussed. Additionally, antibacterial and antifungal agents that can also be used for treatment of protozoal infections, such as the 5-nitroimidazoles, trimethoprim-sulfamethoxazole, azithromycin, and amphotericin, are not discussed in detail here, but their general indications for parasitic infections are shown in Tables 1 and 2. Resistance to antiparasitic agents and drug susceptibility testing are dealt with in separate chapters. Throughout this chapter, we indicate which antiparasitic drugs are currently approved by the U.S. Food and Drug Administration (FDA). For those based in other countries, a table of national and regional drug regulatory authorities is provided at the end of the chapter.
Original languageEnglish
Title of host publicationManual of Clinical Microbiology
EditorsKaren C. Carroll, Michael A. Pfaller, Marie Louise Landry, Alexander J. McAdam, Robin Patel, Sandra S. Richter, David W. Warnock
Place of PublicationWashington DC USA
PublisherASM Press
Chapter152
Pages2645-2668
Number of pages24
Edition12th
ISBN (Print)9781555819835
DOIs
Publication statusPublished - 2019

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