Ophthalmologic Manifestations of Onchocerciasis Medication

  • Author: Deborah R Eezzuduemhoi, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Apr 26, 2010
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

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Antiparasitic agents

Class Summary

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.

In addition to the agents described below, DEC (Hetrazan), a microfilaricidal, was used. It remains the main drug in the management of loiasis due to Loa loa. No longer recommended for treatment of O volvulus. Absorbed from gastrointestinal tract, excreted unchanged in urine in most part, with small amount as N -oxide metabolite. Amocarzine (CGP6140) 4-methyl-4'-(p-nitroanilino) thio-1-piperazinecarboxanilide is an antifilarial anthelmintic isolated from amoscanate. Active against adult worms of O volvulus. Under investigation for oral treatment of onchocerciasis.

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Ivermectin (Mectizan, Stromectol)

 

Semisynthetic, broad-spectrum antiparasitic agent isolated from Streptomyces avermitilis. It is a mixture of 5-O demethyl-22,23-dihydroavermectin A (90%) and 5-O demethyl-25-de (1-methylpropyl)-22,23-dihydro-25- (1-methylethyl) avermectin A1a (10%).

Selectively binds to glutamate-gated chloride ion channels in muscles and nerve cells of the invertebrate. Increased permeability of cell membrane to chloride ions leads to hyperpolarization of the nerve or muscle cell, paralysis, and death of the parasite.

Active against various life-cycle stages of many nematodes, including microfilariae of O volvulus but has no effect on adult worm.

Metabolized in liver. Plasma half-life is 16 hours, 99% excreted in feces and 1% in urine. Available as 6 mg tab for oral administration. Given as single dose of 12 mg (two 6 mg tab) or 150 mcg/kg.

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Suramin (Antrypol)

 

Chemical name: The symmetrical 3"-urea of the sodium salt of 8- (3-benzamido-4-methylbenzamido) naphthalene-1,3,5—trisulphonic acid. Administered by slow IV injection as 10% solution. Only drug effective against adult worms of O volvulus. Primarily indicated for severely afflicted, otherwise healthy adults with salvageable vision.

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Contributor Information and Disclosures
Author

Deborah R Eezzuduemhoi, MD  Assistant Professor, Department of Ophthalmology and Visual Sciences, Texas Tech University, Health Sciences Center School of Medicine

Deborah R Eezzuduemhoi, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, and Women in Ophthalmology, Inc

Disclosure: Nothing to disclose.

Coauthor(s)

Deborah Wilson, MD  Director of Glaucoma Service, Assistant Professor, Department of Ophthalmology, Georgetown University Medical Center

Deborah Wilson, MD is a member of the following medical societies: American Academy of Ophthalmology and American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

John D Sheppard Jr, MD, MMSc  Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, American Uveitis Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

R Christopher Walton, MD  Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, Assistant Dean for Graduate Medical Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital

R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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  2. Awadzi K, Edwards G, Opoku NO, et al. The safety, tolerability and pharmacokinetics of levamisole alone, levamisole plus ivermectin, and levamisole plus albendazole, and their efficacy against Onchocerca volvulus. Ann Trop Med Parasitol. Sep 2004;98(6):595-614. [Medline].

  3. Ayong LS, Tume CB, Wembe FE, et al. Development and evaluation of an antigen detection dipstick assay for the diagnosis of human onchocerciasis. Trop Med Int Health. Mar 2005;10(3):228-33. [Medline].

  4. Cooper PJ, Guderian RH, Proano R, et al. Absence of cellular responses to a putative autoantigen in onchocercal chorioretinopathy. Cellular autoimmunity in onchocercal chorioretinopathy. Invest Ophthalmol Vis Sci. Feb 1996;37(2):405-12. [Medline].

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  7. Nguyen JC, Murphy ME, Nutman TB, et al. Cutaneous onchocerciasis in an American traveler. Int J Dermatol. Feb 2005;44(2):125-8. [Medline].

  8. Pearlman E, Hall LR, Higgins AW, et al. The role of eosinophils and neutrophils in helminth-induced keratitis. Invest Ophthalmol Vis Sci. Jun 1998;39(7):1176-82. [Medline].

  9. Rowe SG, Durand M. Blackflies and whitewater: onchocerciasis and the eye. Int Ophthalmol Clin. Winter 1998;38(1):231-40. [Medline].

  10. World Health Organization. A new drug for river blindness?. Research and Training in Tropical Diseases (TDR) News. Dec 2007;79.

  11. World Health Organization/Onchocerciasis Control Programme. West Africa Without Onchocerciasis. World Health Organization/Onchocerciasis Control Programme; 1997.

 
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