Antihelminthic Drugs

Definition

Antihelminthic drugs are used to treat parasitic infestations.

Purpose

Parasitic infestations are caused by protozoa or worms gaining entry into the body. Most of these organisms cause infections by being ingested in the form of eggs or larvae, usually present on contaminated food or clothing, while others gain entry through skin abrasions. Common parasitic infestations include amebiasis, malaria, giardiasis, hookworm, pinworm, threadworm, whipworm and tapeworm infestations. Once in the body, parasitic worms may go unnoticed if they cause no severe symptoms. However, if they multiply rapidly and spread to a major organ, they can cause very serious and even life-threatening conditions. Antihelminthic drugs are prescribed to treat these infestations. They function either by destroying the worms on contact or by paralyzing them, or by altering the permeability of their plasma membranes. The dead worms then pass out of the body in the feces.

Description

Antihelminthic drugs are available only with a prescription and are available as liquids, tablets or capsules. Some commonly used antihelminthics include: albendazole (Albenza), mebendazole (Vermox), niclosamide (Niclocide), oxamniquine (Vansil), praziquantel (Biltricide), pyrantel (Antiminth), pyantel pamoate (Antiminth) and thiabendazole (Mintezol). Some types of parasitic infestations are rarely seen in the United States, thus, the corresponding antihelminthic drugs are not widely distributed and need to be obtained fromt he United States Center for Disease Control (CDC) when required. These include for example bitional and ivermectin, used to treat onchocerciasis infestations. Other antihelminthic drugs, such as diethylcarbamazepine citrate (Hetrezan), used for treatment of roundworms and other parasites, is supplied directly by its manufacturer when needed.

Most antihelminthic drugs are only active against specific parasites, some are also toxic. Before treatment, the parasites must therefore be identified using tests that look for parasites, eggs or larvae in feces, urine, blood, sputum, or tissues. Thus, niclosamide is used against tapeworms, but will not be effective for the treatment of pinworm or roundworm infestations, because it acts by inhibiting ATP production in tapeworm cells. Thiabendazole (Mintezole) is the drug usually prescribed for treatment of threadworm, but a similar drug, mebendazole (Vermox) works better on whipworm by disrupting the microtubules of this worm. Praziquantel is another drug that acts by altering the membrane permeability of the worms.

Preparation

Dosage is established depending on the patient's general health status and age, the type of antihelminthic drug used, and the type of parasitic infestation being treated. The number of doses per day, the time between doses, and the length of treatment will also depend on these factors.

Antihelminthic drugs must be taken exactly as directed to completely rid the body of the parasitic infestation, and for as long as directed. A second round of treatment may be required to ensure that the infection has completely cleared.

Precautions

Some antihelminthic drugs work best when ingested along with fatty foods, such as milk or ice cream. Oral drugs should be taken with water during or after meals. The prescribing physician should be informed if the patient has a low-fat or other special diet.

Some antihelminthic drugs, such as praziquantel, come in chewable form. These tablets should not be chewed or kept in the mouth, but should swallowed whole because their bitter taste may cause gagging or vomiting.

Antihelminthic drugs sometimes need to be taken with other medications. For example, steroids such as prednisone are also prescribed together with the antihelminthic drug for tapeworm to reduce the inflammation that the worm may cause.

When required, pre- or post-treatment purges are also performed with magnesium or sodium sulfate.

Regular medical visits are recommended for people affected by parasitic infestations. The physician monitors whether the infection is clearing or not and also keeps track of unwanted side effects. The prescribing physician should be informed if symptoms do not disappear or if they get worse.

Hookworm or whipworm infections are also treated with iron supplements along with the antihelminthic prescription.

KEY TERMS

Amebiasis— Parasitic infestation caused by amebas, especially by Entamoeba histolytica.

Colitis— Inflammation of the colon (large intestine).

Feces— The solid waste that is left after digestion. Feces form in the intestines and leave the body through the anus.

Flukes— Parasite worms that look like leeches. They usually have one or more suckers for attaching to the digestive mucosa of the host. Liver flukes infest the liver, destroying liver tissue and impairing bile production and drainage.

Giardiasis— Parasitic infestation caused by a flagellate protozoan of the genus Giardia, especially by G. lamblia.

Hallucination— A false or distorted perception of objective reality. Imaginary objects, sounds, and events are perceived as real.

Hookworm— Parasitic intestinal infestation caused by any of several parasitic nematode worms of the family Ancylostomatidae. These worms have strong buccal hooks that attach to the host's intestinal lining.

Larva— The immature, early form of an organism that at birth or hatching is not like its parent and has to undergo metamorphosis before assuming adult features.

Malaria— Disease caused by the presence of sporozoan parasites of the genus Plasmodium in the red blood cells, transmitted by the bite of anopheline mosquitoes, and characterized by severe and recurring attacks of chills and fever).

Microtubules— Slender, elongated anatomical channels in worms.

Nematode— Roundworm.

Organism— A single, independent life form, such as a bacterium, a plant or an animal.

Parasite— An organism that lives in or with another organism, called the host, in parasitism, a type of association characterized by the parasite obtaining benefits from the host, such as food, and the host being injured as a result.

Parasitic— Of, or relating to a parasite.

Pinworm— Enterobius vermicularis, a nematode worm of the family Oxyuridae that causes parasitic infestation of the intestines and cecum. Pinworm is endemic in both temperate and tropical regions and common especially in school age children.

Onchocerciasis— Parasitic infestation caused by filamentous worms of the genus Onchocerca, especially O. volvulus, that is found in tropical America and is transmitted by several types of blackflies.

Protozoan— Any unicellular or multicellular organism containing nuclei and organelles (eukaryotic) of the subkingdom Protozoa.

Roundworm— Any round-bodied unsegmented worm as distinguished from a flatworm. Also called a nematode, they look similar to the common earthworm.

Tapeworm— Flat and very long (up to 30 meters) intestinal parasitic worms, similar to a long piece of tape. Common tapeworms include: T. saginata (beef tapeworm), T. solium (pork tapeworm) D. latum (fish tapeworm), H. Nana (dwarf tapeworm) and E. granulosus (dog tapeworm). General symptoms are vague abdominal discomfort, nausea, vomiting, diarrhea and weight loss.

Threadworm— Any long, thin nematode worm.

Trematode— Any parasitic flatworm of the class Trematoda, as the liver fluke.

Whipworm— A nematode worm of the family Trichuridae with a body that is thick at one end and very long and slender at the other end.

Some types of parasitic infestations (e.g. pinworms) can be passed from one person to another. It is then often recommended that everyone in the household of an infected person be asked to also take the prescribed antihelminthic drug.

Risks

People with the following medical conditions may have adverse reactions to antihelminthic drugs. The prescribing physician should accordingly be informed if any of these conditions are present:

• Allergies. Anyone who has had adverse reactions to antihelminthic drugs should inform the prescribing physician before taking the drugs again. The physician should also be informed about any other preexisting allergies.
• Ulcers. Antihelminthic drugs are also contraindicated for persons diagnosed with ulcers of the digestive tract, especially ulcerative colitis.
• Pregnancy. There is research evidence reporting that some antihelminthic drugs cause birth defects or miscarriage in animal studies. No human birth defects have been reported, but antihelminthic drugs are usually not recommended for use during pregnancy. Pregnant women should accordingly inform the prescribing physician.
• Breastfeeding. Some antihelminthic drugs can pass into breast milk. Breastfeeding may have to be discontinued until the antihelminthic treatment has ended and breastfeeding mothers must also inform the prescribing physician.
• Other risk conditions. Any of the following medical conditions should also be reported to the prescribing physician: Crohn's disease, liver disease, kidney disease and worm cysts in the eyes.

Common side effects of antihelminthic drugs include dizziness, drowsiness, headache, sweating, dryness of the mouth and eyes, and ringing in the ears. Anyone taking these drugs should accordingly avoid driving, operating machines or other activities that may be dangerous until they know how they are affected by the drugs. Side effects usually wear off as the body adjusts to the drug and do not usually require medical treatment. Thiabendazole may cause the urine to have an unusual odor that can last for a day after the last dose. Other side effects of antihelminthic drugs, such as loss of appetite, diarrhea, nausea, vomiting, or abdominal cramps are less common. If they occur, they are usually mild and do not require medical attention.

More serious side effects, such as fever, chills, confusion, extreme weakness, hallucinations, severe diarrhea, nausea or vomiting, skin rashes, low back pain, dark urine, blurred vision, seizures, and jaundice have been reported in some cases. The patient's physician should be informed immediately if any should develop. As a rule, anyone who has unusual symptoms after starting treatment with antihelminthic drugs should notify the prescribing physician.

Antihelminthic drugs may interact with each other or with other drugs, whether prescribed or not. For example, it has been reported that use of the antihelminthic drugs pyrantel and piperazine together lowers the efficiency of pyrantel. Similarly, combining a given antihelminthic drug with another medication may increase the risk of side effects from either drug.

Antihelmintics

Antihelmintics are drugs used to kill parasitic worms. The origin of the word antihelmintic is the Greek word helmins, meaning worm. These preparations are also called vermicides.

Worm infestations are among the most common parasitic diseases of man. Often the life cycle of the worm begins when a child playing in dirt ingests the eggs of the worm. The egg hatches in the child’s digestive tract, and the worms begin to reproduce, make more eggs, and infect more hosts.

Parasitic worms may be either round (called nematodes), or have a segmented, flat configuration (called cestodes). Worms are most problematic in areas where sanitation is poor.

The most common parasitic worm infestation in non-tropical climates is by the pinworm (Enterobias vermicularis ), which is highly infectious and may affect an entire family before the infection is diagnosed. At any time, up to 20% of the childhood population has pinworms; this may jump to 90% among children who are institutionalized, as in an orphanage.

Other roundworm infections are by the hookworm and whipworm, either of which can gain entrance to the body by penetrating the skin of a bare foot. Trichinosis derives from eating raw or undercooked pork containing the worm larva.

Flat, segmented worms, also called tapeworms, can originate in raw beef, pork, or fish. These worms attach their heads to the walls of the intestine and shed square segments that are packages of eggs.

Most roundworm infestations can be cleared by taking pyrantel pamoate, a drug for sale over the counter. It was developed in 1972 as a prescription drug. Because it is given in the form of a pill or syrup in a single dose, based on body weight, and has no serious side effects, pyrantel was approved for non-prescription sale. This medication relaxes the muscles to which the worm attaches on the intestinal wall so the worm is passed out with a normal fecal movement.

Other, more potent drugs are available by prescription to treat worm infections. They include piper-azine, tetrachloroethylene, and thiabendazole for roundworms, and niclosamide for tapeworms.

Antihelmintics are very effective at eliminating worm infections. For example, benzimidazole compounds achieve a cure in almost all who are treated. The elimination of infection does not guarantee against re-infection. Thus, in areas where worm infections are common, repeated treatment with antihelmintics can be a fact of life.

See also Parasites.

Larry Blaser

Antihelmintics

Antihelmintics are drugs used to kill parasitic worms (from the Greek word helmins, worm). These preparations are also called vermicides.

Worm infestations are among the most common parasitic diseases of man. Often the life cycle of the worm begins when a child playing in dirt ingests the eggs of the worm. The egg hatches in the child's digestive tract and the worms begin their unending quest to reproduce, make more eggs, and infect more hosts.

Parasitic worms may be either round (called nematodes), or have a segmented, flat configuration (called cestodes). Worms are most problematic in areas where sanitation is poor.

The most common parasitic worm infestation in nontropical climates is by the pinworm (Enterobias vermicularis), which is highly infectious and may affect an entire family before the infection is diagnosed. At any time, up to 20% of the childhood population has pinworms and may jump to 90% among children who are institutionalized, as in an orphanage.

Other roundworm infections are by the hookworm and whipworm, either of which can gain entrance to the body by penetrating the skin of a bare foot. Trichinosis derives from eating raw or undercooked pork containing the worm larva.

Flat, segmented worms, also called tapeworms, can originate in raw beef, pork, or fish . These worms attach their heads to the walls of the intestine and shed square segments that are packages of eggs.

Most roundworm infestations can be cleared by taking pyrantel pamoate, a drug for sale over the counter. It was developed in 1972 as a prescription drug. Because it is given in the form of a pill or syrup in a single dose, based on body weight, without serious side effects, pyrantel was approved for nonprescription sale. This medication relaxes the muscles that the worm holds on to on the intestinal wall so the worm is passed out with a normal fecal movement.

Other, more potent drugs are available by prescription to treat worm infections. They include piperazine, tetrachloroethylene, and thiabendazole for roundworms , and niclosamide for tapeworms.

See also Parasites.

Larry Blaser