Term
symptomatic giardiasis/2nd-3rd trimester = metronidazole
pregnancy = paromomycin
pediatrics/metronidazole non-responders = nitazoxanide |
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Definition
treatment of giardiasis protozoal infection):
symptomatic
2nd-3rd trimester
pregnancy
pediatrics
non-responders |
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Term
resolution of diarreha (1-2 weeks)
cyst excretion (w/in days)
complete resolution of intestinal dysfunction (~3 months): transit time, radiologic changes |
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Definition
| evaluation of giardiasis treatment protozoal infection) |
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Term
exclusive consumption of non-contaminated food and water
cook food adequately
boil or filter potentially contaminated water
iodine disinfection of water is more effective than chlorine treatment
treat asymptomatic carriers who may serve as a source of infection to others
adhere to strict hand washing protocol
dispose of diapers carefully
breast feeding confers some protection for nursing infants through secretory IgA - particularly important in developing countries |
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Definition
| giardiasis prevention protozoal infection) |
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Term
luminal agents - mild to moderate infection:
(DIP)
diloxanide
iodoquinol
paromomycin in pregnancy
systemic agents - moderate to severe infection with liver involvement:
metronidazole
chloroquine |
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Definition
treatment of amoebiasis protozoal infection)
luminal agents
systemic agents |
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Term
monitor imaging
monitor stool samples over 1-3 months
GI involvement may resolve in 3-5 days
liver involvement may resolve in 7-10 days (may continue to heal for up to 8 months). if no response may require abscess aspiration/exploratory laparotomy |
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Definition
| evaluation of amoebiasis treatment protozoal infection) |
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Term
adequate sanitation and eradication of cyst carriage
in high risk areas, infections may be minimized by:
avoidance of unpeeled, uncooked fruits and vegetables that may have been washed in local water
use of bottled water
disinfection by iodination is recommended b/c cysts are resistant to readily attainable levels of chlorine
there is no effective pharmacologic prophylaxis |
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Definition
| amoebiasis prevention (protozoal infection) |
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Term
may be used to treat giardiasis and amoebiasis
it is a nitroimidazole
no alcohol, possible urine discoloration, and may cause dizziness |
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Definition
| clinical pearls of metronidazole |
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Term
can be used in pregnancy for giardiasis and amoebiasis
aminoglycoside
renal and ototoxicity |
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Definition
| clinical pearls for paromomycin |
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Term
can be used for giardiasis in metronidazole non-responders
prodrug, active metabolite is tizoxanide
patients should take with food |
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Definition
| clinical pearls of nitazoxanide |
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Term
can be used for amoebiasis
halogenated hydroxyquinoline
amebicidal, intestinal |
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Definition
| clinical pearls of iodoquinol |
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Term
mebendazole
albendazole
follow-up stool sample to ensure eradication and 2nd course of treatment PRN continued infection |
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Definition
| treatment of hookworm disease (helminth infection) |
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Term
improvements in fecal sanitation
use of footwear
iron supplementation of food in endemic areas
periodic mass therapy in endemic areas (expensive)
significant protective immunity to intestinal nematodes appears not to develop naturally in humans. vaccine development is being pursued. |
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Definition
| hookworm disease prevention (helminth infection) |
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Term
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Definition
| treatment of ascariasis (helminth infection) |
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Term
pyrantel pamoate
mebendazole
albendazole
all bedding and clothing should be washed
additionally, frequent hand washing and clipping fingernails to decrease ongoing transmission and re-infection |
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Definition
| treatment of enterobiasis (pinworm)(helminth infection) |
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Term
enterobiasis (pinworm)
strongyloidiasis |
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Definition
| parasitic infections that can be transmitted by autoinfection |
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Term
ivermectin
albendazole
hyperinfection
D/C immunosuppression
initiate ivermectin
periodic screenings to ensure eradication |
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Definition
| treatment of strongyloidiasis (helminth infection) |
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Term
prevention of initial infection:
improved fecal sanitation in endemic areas
avoidance of skin contact with potentially contaminated soil
screening/treatment of at-risk patients before initiation of immunosuppressive therapy |
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Definition
| strongyloidiasis prevention (helminth infection) |
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Term
albendazole
praziquantel
pharm treatment generally deemed controversial, surgical options may be considered |
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Definition
| treatment of cysticercosis/neurocysticercosis (helminth infection) |
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Term
eradiation of cysticerci by:
adequate cooking of infected pork
exposure to temperatures as low as 56 C for 5 minutes
refrigerate or salting for long periods
freezing at -9 C for 9 days
minimize opportunities for ingestion of fecally derived eggs through:
good personal hygiene
effective fecal disposal
treatment and prevention of human intestinal infections |
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Definition
| prevention of cysticercosis/neurocysticercosis (helminth infection) |
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Term
mebendazole: used for hookworm, ascariasis, and enterobiasis (pinworm) = helminth infections
albendazole: used for hookworm, ascariasis, enterobiasis (pinworm), strongyloidiasis, and cysticerosis/neurocysticerosis = helminth infections
may take weeks to see results and focus on education to avoid reinfection and further spread of parasite |
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Definition
| clinical pearls of benzimidazole class |
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Term
used for enterobiasis (pinworm) = helminth infection
may cause dizziness and somnolence |
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Definition
| clinical pearls of pyrantel pamoate |
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Term
used for stronyloidiasis = helminth infection
may cause orthostatic hypotension
take drug on an empty stomach with water: 2.5x increase in BA when taken w/ food
taking w/out food limits side effects |
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Definition
| clinical pearls of ivermectin |
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Term
used for cysticerosis/neurocysticerosis = helminth infections
may cause diziness |
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Definition
| clinical pearls of praziquantel |
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Term
TREATMENT DEPENDS ON GEOGRAPHICAL AREA, RESISTANCE/SENSITIVITY PATTERNS, AND PLASMODIUM SPP.
chloroquine or hydroxycholoroquine
atovaquone-proguanil
artemether-lumefantrine
mefloquine
quinine + tetracycline or doxycycline
quinidine + tetracycline, doxycycline, or clindamycin
artesuante - not available in the US |
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Definition
| treatment options for malaria |
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Term
dosed per body weight
should not exceed adult dosing
tetracycline and doxycycline not recommended (patients < 8 yo) |
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Definition
| treatment of malaria in pediatrics |
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Term
malaria parasite sequester and replicate in the placenta
many complications including miscarriage and death of the fetus
3x more likely to develop severe infection vs. non-pregnancy females
may require alternative medications: chloroquine, quinine, clindamycin recommendation depends of resistance/susceptibility patterns
risk vs. benefit assessment (most are category C/D
lactation consideration post delivery |
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Definition
| treatment of malaria in pregnancy |
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Term
malarone, chloroquine, hydroxychloroquine, doxycycline, mefloquine, primaquine
treatment selection:
geographic area of travel
resistance/sensitivity patterns
generally 1-2 days before travel, qd during stay, and continued 4 weeks post travel
exception: malarone - 1-2 days before, during, and 7 days after
primaquine: considered for terminal prophylaxis, contraindicated for G6PD deficient individuals |
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Definition
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Term
contact CDC - avoid outbreaks
plan daily activities to avoid peak exposure times and places, night better than day
wear appropriate clothing
mosquito netting
insecticides: DEET, picaridin, oil of lemon eucalyptus
treat clothing and other equipment: premethrin (pretreatment), DEET (reapplication post-wash) |
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Definition
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Term
premethrin - 10 minutes
malathion - 90 minutes
lindane - 4 minutes, dosed of length of hair |
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Definition
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