TAILIEUCHUNG - Ebook Antibiotic and chemotherapy expert consult (9th edition): Part 2
Part 2 book "Antibiotic and chemotherapy expert consult" presentation of content: Anthelmintics, antiprotozoal agents, antiretroviral agents, other antiviral agents, treatment, abdominal and other surgical infections, infections associated with neutropenia and transplantation, infections associated with implanted medical devices,. and other content. | Chapter 34 Anthelmintics George A. Conder The helminths, or parasitic worms, comprise the nematodes (roundworms), trematodes (flukes), cestodes (tapeworms) and acanthocephalans (thorny-headed worms). Most anthelmintics were discovered and developed for use in the veterinary field, where helminths significantly impact health and productivity. Few companies are searching for new compounds for use in human medicine, but commercial competition has produced a steady supply of new products for the veterinarian. Three new classes of anthelmintic (cyclic octadepsipeptides, amino-acetonitrile derivatives and paraherquamides) have entered or will soon enter the veterinary market and these have potential for human medicine. In addition, some members of established classes have exhibited promising results in preliminary investigations (moxidectin for filariasis; artemisinins for schistosomiasis). Despite the lack of new anthelmintics for human treatment, satisfactory results can be achieved with current products for nearly all helminth infections. In some cases such as for filariasis, combinations of available drugs are being used to enhance treatment. Side effects usually include gastrointestinal upsets, but these are as likely to be related to the worm burden as to the drug. As helminths are often large and/or present in large numbers, their death and disintegration after chemotherapy can result in an obstruction or an allergic–anaphylactic type reaction. The biggest problems still remaining to be solved are treatment of infections with larval cestodes, especially Echinococcus spp. There is no satisfactory drug against these parasites; although benzimidazole carbamates have useful activity, they are poorly absorbed from the gut when administered orally and painful injection-site reactions preclude parenteral use. Praziquantel also may be useful in some cases for larval cestodes. Another problem is the treatment of disseminated strongyloidiasis, which occurs when patients
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