AMOEBICIDES DRUGS GET DEEP UNDERSTANDING

Amoebicides Drugs 

 STEP 2: Indications of Amoebicides Drugs

Amoebicides listed on essential medicine list include metronidazole and tinidazole.

Indications of Amoebicides Metrinidazole is the drug of choice in the treatment of all tissue infections with E histolytica. They are not reliably effective against luminal parasites and so must be used with a luminal amebicide to ensure eradication of the infection.

Tinidazole like metronidazole, it is also the drug of choice in the treatment of all tissue infections with E histolytica. They are not reliably effective against luminal parasites and so must be used with a luminal amebicide to ensure eradication of the infection.

STEP 3: Contraindication of Amoebicides

Metrinidazole and Tinidazole are contraindicated to people who have taken alcohol.

STEP 4: Dose, Dosage and Course of Amoebicides:

Metronidazole By mouth, invasive intestinal amoebiasis, extraintestinal amoebiasis (including liver abscess), 800 mg every 8 hours for 5 days in intestinal infection (for 510 days in extra-intestinal infection) .

Children 13 years 200 mg every 8 hours; 37 years 200 mg every 6 hours; 7 to 10 years 400 mg every 8hours 

Tinidazole Intestinal amoebiasis, 2 g daily for 23 days; 

Children 5060 mg/kg daily for 3 days.

Amoebic involvement of liver, 1.52 g daily for 36days.

Children 5060 mg/kg daily for 5 days. 

 STEP 5: Side Effects and Adverse Effects of Amoebicides:

Side and adverse effects of amoebicides  

Metrinidazole and Tinidazole

Gastro-intestinal disturbances (including nausea and vomiting), Taste disturbances, furred tongue, oral mucositis, anorexia

Very rarely hepatitis, jaundice, pancreatitis.

 Drowsiness, dizziness, headache, ataxia, psychotic disorders.

Darkening of urine Thrombocytopenia, pancytopenia Myalgia, arthralgia.  Visual disturbances, Rash, pruritus, and erythema multiform On prolonged or intensive therapy peripheral neuropathy, transient epileptiform seizures

 STEP 6: Interaction and Precaution of Amoebicides

Metrinidazole and Tinidazole:

Disulfiram-like reaction with alcohol, there for it should never be given with alcohol or where there is a suspected use of alcohol.

Hepatic impairment and hepatic encephalopathy

Pregnancy Breast-feeding 

Avoid in acute porphyria

Clinical and laboratory monitoring advised if treatment exceeds 10 days

 STEP 7: Key Points

Metrinidazole and Tinidazole are common medicines in amoebiasis.

Metrinidazole and Tinidazole should not given to patient who have taken alcohol.

Long term use of Metrinidazole and Tinidazole need clinical and laboratory monitoring.

Long course and higher dose is required in liver abscess.

 

STEP 7: References

Ministry of Health and Social Welfare. (2013).

Standard Treatment Guidelines & National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania government printers.

Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael. (2014).

Pharmacotherapy: A Pathophysiologic Approach (9th ed.). New York, McGraw-Hill Education. Sally S.R, Jeanne C.S. (2000).

Introductory Clinical Pharmacology (6th ed) New York, Lippincott Williams and Wilkins.

School of Pharmaceutical sciences. (2011).Tanzania Pharmaceutical Handbook (2nd ed.). Dar es Salaam, ARDHI University press.

The Royal Pharmaceutical Society of Great Britain. (2007).

Martindale, the Extra Pharmacopoeia (5TH ed). London, pharmaceutical press.

The Royal Pharmaceutical Society of Great Britain. 2009.

British National Formulary (59th ed). London, BMJ Group and RPS Publishing.