Drugs that are used to treat
African sleeping sickness
Suramin:
Mechanism of action is uncertain.
Used to treat
Trypanosoma brucei rhodesiense infections with no central nervous system involvement (usually early infection).
Can also be used to treat River blindness caused by the nematode
Onchocerca volvulus.
Adverse effects can include hypersensitivity reaction leading to shock and loss of consciousness and renal toxicity.
Melarsoprol:
Arsenic compound used to treat Trypanosoma brucei rhodesiense infections when the CNS is involved.
Post-treatment reactive encephalopathy can occur.
Pentamidine:
Uncertain mechanism.
Treats infection caused by Trypanosoma brucei gambiense when there is no CNS involvement.
This drug is associated with several adverse effects, including hypotension, dizziness, and nausea, as well as leukopenia and thrombocytopenia, electrolyte disturbances, hypo- and hyper-glycemia, and cardiac and renal effects.
Eflornithine:
Inhibits the enzyme ornithine decarboxylase, which is needed for cell growth and proliferation.
Used to treat Trypanosoma brucei gambiense when there is CNS involvement.
It may be combined with nifurtimox.
Adverse effects include vomiting, abdominal pain, dizziness, arthalgias, rash, hair loss, and others.
Benznidazole:
Uncertain mechanisms.
Used to treat
Trypanosoma cruzi infection, often referred to as Chagas disease.
Nifurtimox is a second choice for Chagas disease treatment.
Benznidazole is associated with peripheral neuropathy, allergic dermatitis, insomnia and weight loss. Be aware that the risks of adverse effects increase with age.
Metronidazole:
Thought to increase free radicals to toxic levels.
Used to treat infections caused by two flagellates,
Giardia duodenalis and
Trichomonas vaginalis as well as an amoeba,
Entamoeba histolytica.
These infections may also be treated with tinidazole.
Metronidazole is also used to treat anaerobic bacterial infections.
Adverse effects include gastrointestinal problems, as well as a metallic taste in the mouth and the feeling of a "furry" tongue. Others include dark urine and hypersensitivity reactions. Be aware that at high doses, neurotoxicity can occur.
Nitrazoxanine:
Interferes with anaerobic metabolism.
Treats infections caused by Giardia duodenalis and Cryptosporidium.
Adverse effects include gastrointestinal problems, head ache, and hair loss.
Pyrimethamine and sulfadiazine:
Fansidar
Acts as an antifolate to treat infections caused by
Toxoplasma gondii and
Cystoisospora belli.
And, as we learn elsewhere, Fansidar is used to treat
malarial infections).
At high doses, this drug may cause folate deficiency and bone marrow suppression; to avoid this, give folinic acid.
Bactrim: Trimethoprim + Sulfamethoxazole
An antifolate.
Used to treat infection caused by the apicomplexans Cystoisospora belli and
Cyclospora cayetanensis.
Also used to treat Pneumocystis, which is now categorized as a species of fungi.
Bactrim is associated with gastrointestinal problems and rash, which are worse in HIV patients.
Hemolytic anemia can occur in patients with G6PD deficiency.
