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Pediatric Schistosomiasis Medication

  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: Russell W Steele, MD  more...
 
Updated: Feb 26, 2015
 

Medication Summary

Praziquantel (a pyrazinoquinolone) has become the main antischistosomal agent because it is effective against all human pathogens and is well tolerated orally. Other oral compounds available are oxamniquine (a nitroquinolone that is no longer available in the United States) and metrifonate (an organophosphorus cholinesterase inhibitor that is also unavailable in the United States), but these have limited parasite specificity.

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Anthelmintics

Class Summary

Parasite biochemical pathways are different from those of the human host; thus, toxicity is directed to the parasite, egg, or larvae. The mechanism of action varies within the drug class. Antiparasitic actions may include the following:

- Inhibition of microtubules, causing irreversible block of glucose uptake

- Tubulin polymerization inhibition

- Depolarizing neuromuscular blockade

- Cholinesterase inhibition

- Increased cell membrane permeability, resulting in intracellular calcium loss

- Vacuolization of the schistosome tegument

- Increased cell membrane permeability to chloride ions via chloride-channel alteration

Praziquantel (Biltricide)

 

Animal studies report that praziquantel induces rapid contraction of schistosomes by exerting a specific effect on the permeability of the cell membrane. The drug further causes vacuolization and disintegration of the schistosomal tegument. It has a more marked effect on adult worms than on young worms. After oral administration, praziquantel is rapidly absorbed (80%). It is subject to a first-pass effect and extensive metabolism.

Oxamniquine

 

Oxamniquine is no longer available in the United States. It is active only against S mansoni. Oxamniquine is effective in disintegrating the schistosome tegument to which phagocytes attach, causing death.

The drug is well absorbed and is metabolized extensively to inactive metabolites that, in turn, are excreted in urine. The plasma half-life is approximately 1-2.5 hours, and a peak in drug concentrations is usually reached in 1-1.5 hours after oral administration.

Metrifonate

 

Metrifonate, an organophosphate derivative with anthelmintic and anticholinesterase activity, is not available in the United States. It is used as an alternative to praziquantel for treatment of S haematobium infections; it is not effective for S japonicum or S mansoni infections. The drug is well absorbed from the gastrointestinal (GI) tract, with peak levels occurring 1 hour after administration.

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Contributor Information and Disclosures
Author

Vinod K Dhawan, MD, FACP, FRCPC, FIDSA Professor, Department of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Infectious Diseases, Rancho Los Amigos National Rehabilitation Center

Vinod K Dhawan, MD, FACP, FRCPC, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Pfizer Inc for speaking and teaching.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Michael D Nissen, MBBS, FRACP, FRCPA, Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital

Michael D Nissen, MBBS, FRACP, FRCPA is a member of the following societies : American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society,Royal Australasian College of Physicians, Royal College of Pathologists of Australasia

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

John Charles Walker, MSc, PhD Head, Department of Parasitology, Center for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, Australia; Senior Lecturer, Department of Medicine, University of Sydney, Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
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Cercarial dermatitis secondary to avian schistosomes is shown. Photography taken by A. Joseph Bearup and provided by John Walker, MD.
Two 10-year-old boys with abdominal distension secondary to chronic Schistosoma japonicum infection.
CT scan of the brain reveals a right cerebral hemisphere lesion due to Schistosoma japonicum. The patient presented with focal motor seizures.
Egg of Schistosoma japonicum from a fecal smear is shown. Note lateral umbilicated spine on the right side of the egg.
Egg of Schistosoma mekongi (53 X 45 μm) in the feces of a woman from Laos.
Egg of Schistosoma mansoni from a fecal smear.
Egg of Schistosoma haematobium from a fecal smear.
Eggs of Schistosoma japonicum within the intestinal mucosa.
Liver granulomata secondary to Schistosoma japonicum infestation.
Granuloma within the intestinal mucosa secondary to Schistosoma mansoni infestation.
Eggs of Schistosoma haematobium isolated from urinary sediment.
Eggs of Schistosoma haematobium detected in the bladder.
 
 
 
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