Updated: 9/23/2019

Anti-Protozoal Drugs

Topic
Review Topic
0
0
Introduction
  • Drugs
    • pyrimethamine
    • sulfadiazine
    • suramin
    • melarsoprol
    • nifurtimox
    • sodium stibogluconate
    • metronidazole
    • amphotericin B
    • benznidazole
    • nitazoxanide
  • Clinical use
    • protozoa
      • treatment
    • see anti-malarials topic for malaria-specific treatments
Anti-Malarial Medications
Drug Mechanism of Action
Adverse Effects
Indications

Pyrimethamine + sulfadiazine

  • Pyrimethamine: folic acid antagonist
  • Sulfadiazine: competitive antagonism with para-aminobenzoic acid (also anti-folate)
  • Gastrointestinal upset
  • Drug rash
  • Pancytopenia
  • Folate deficiency
    • co-administer with leucovorin
  • Toxoplasma gondii
Suramin
  • Unknown but inhibits trypanosomal energy metabolism
  • Gastrointestinal upset
  • Peripheral neuropathy
  • Renal toxicity
  • Trypanosoma brucei, blood-borne disease
Melarsoprol
  • Inhibits pyruvate kinase
  • Brain dysfunction
  • Renal toxicity
  • Hepatic toxicity
  • Trypanosoma brucei, central nervous system disease
Nifurtimox
  • Causes breakdown of DNA via radical metabolite formation
  • Gastrointestinal upset
  • Headache
  • Weight loss
  • Trypanosoma cruzi
Sodium stibogluconate
  • Unknown but may inhibit citric acid cycle and glycolysis in the protozoa
  • Loss of appetite
  • Gastrointestinal upset
  • Myalgias
  • Fatigue
  • Pancreatitis
  • Leishmania donovani
Metronidazole
  • Causes breakdown of DNA via free radical metabolite formation
  • Disulfiram-like reaction with alcohol
  • Headache
  • Metallic taste
  • Giardia lamblia
  • Entamoeba histolytica
  • Trichomonas vaginalis
    • treat the partner too
Amphotericin B
  • Binds ergosterol and allows leakage of electrolytes from the membrane
  • Fevers and chills
  • Hypotension
  • Renal toxicity
  • Arrhythmias
  • Anemia
  • Phlebitis
  • Leishmania donovani
  • Naegleria fowleri
Benznidazole
  • Causes breakdown of DNA via free radical metabolite formation
  • Rash
  • Peripheral neuropathy
  • Myalgias
  • Loss of appetite
  • Bone marrow suppression
  • Trypanosoma cruzi
Nitazoxanide
  • Disrupts anaerobic energy metabolism
  • Gastrointestinal upset
  • Rash
  • Fever
  • Cryptosporidium
 

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