Description of Antihelminthes

Session 12: Description of Antihelminthes

Total Session Time: 120 minutes

Prerequisites

Learning Tasks

By the end of this session students are expected to be able to:

Resources Needed:

SESSION OVERVIEW

Activity/

Step Time Content

Method

1 05 minutes Presentation Introduction, Learning tasks

Presentation/

2 20 minutes Indications of Antihelminthes

Buzzing

Presentation/

3 20 minutes Contraindication of Antihelminthes

Brainstorming

4 30 minutes Presentation Dose, Dosage and Course of Antihelminthes

Presentation/ Side Effects and Adverse Effects of

5 20 minutes

brainstorming Antihelminthes

6 15 minutes Interaction and Precaution of Antihelminthes

Presentation

7 05 minutes Presentation Key Points

8 05 minutes Presentation Evaluation

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SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Indications of Antihelminthes Drugs (20 minutes)

Activity: Buzzing (5minutes)

ASK students to pair up and buzz on the following question for 2 minutes

ALLOW few pairs to respond and let other pairs add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Thiabendazoles. Others include Piperazine and Praziquental

o Mebendazole is effective in treatment of the following parasitic infestations:

 Roundworm

 Thread worms

 Whipworm

 Hook worms

o Albendazole are effective treatment of following parasites:

 Hookworms

 Roundworms

 Tapeworms

 Strongyloides

 Cutaneous lava migrains

o Ivermectin are effective for treatment of:

 Filariasis

 Cutaneous larva migrans

o Niclosamides are effective for treatment of tapeworms

o Thiabendazoles are used in treatment stronyloides

are:

o Piperazine is effective for threadworms and round worms

o Praziquental is used in treatment of schistosomiasis

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STEP 3: Contraindication of Antihelminthes (20 minutes)

Activity: Brainstorming (5 minutes)

ASK learners

ALLOW few learners to respond

WRITE their responses on the flipchart

SUMMARIZE the discussion by the following information

o Pregnancy during first trimester (Mebendazole, albendazole, thiabendazoles)

o Known hypersensitivity to antihelminthes drugs

STEP 4: Dose, Dosage and Course of Antihelminthes (30 minutes)

o Adult and Children above 2 years 100mg 12 hourly for 3 days

Or

o 500mg as a single dose

o 400mg as a single dose

Or

o Adult: 2g as a single dose. Chew tablets on an empty stomach

o For Taenia solium, Taenia saginata and Diphyllobothrium latum

 Adults and children over 6 years: 2g as a single dose after a light breakfast,

followed by a purgative after 2 hours

 Children 2-6 years: 1g as a single dose after a light meal, followed bya purgative

after 2 hours

 Children under 2 years 500mg as a single dose after a light meal, followedby a

purgative after 2 hours

o For Hymenolepsis nana

 Adult and children over 6 years 2g as a single dose on the first day, then 1g daily

for 6 days

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 Children under 2 years 500mg on the first day as a single dose then 250mg daily

for 6 days

 Children 2-6 years 1g on the first day as a single dose then 500mg once daily

 Treat again at intervals of 6 to 12 months, depending on symptoms or until the

adult worms die out

 Increase the dose gradually by 1mg/kgbody at an interval of 3 days to maximum

 Duration of treatment is 21 days

 Tablets must be chewed

o Children Same as for adults

STEP 5: Side Effects and Adverse Effects of Antihelminthes (20 minutes

Activity: Brainstorming (5 minutes)

ASK learners

ALLOW few learners to respond

WRITE their responses on the flipchart

SUMMARIZE the discussion by the following information

o Side effects and adverse effects:

 Very rarely abdominal pain, diarrhoea, convulsions (in infants)

 Rash (including Stevens-Johnson syndrome and toxic epidermal necrolysis)

 Short-term mebendazole therapy for intestinal nematodes is nearly free of adverse

effects

 Mild nausea, vomiting, diarrhoea, and abdominal pain have been reported

infrequently

 Rare side effects, usually with high-dose therapy, are hypersensitivity reactions

(rash, urticaria), agranulocytosis, alopecia, and elevation of liver enzymes

o side-effects and adverse effects:

 Occasional gastro-intestinal upset

 Lightheadedness

 Pruritis

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 Infrequent, mild, and transitory adverse events include nausea, vomiting, diarrhea,

and abdominal discomfort

o Side-effects and adverse effects:

 In strongyloidiasis treatment infrequent side effects includes: Fatigue, dizziness,

nausea, vomiting, abdominal pain, and rashes.

 In onchocerciasis treatment,the adverse effects are principally from the Mazotti

reaction, due to killing of microfilariae

o Side-effects and adverse effects:

 When used for 1-3 days, albendazole is nearly free of significant adverse effects.

 Mild and transient epigastric distress, diarrhea, headache, nausea, dizziness,

lassitude, and insomnia can occur

 In long-term use for hydatid disease, albendazole is well tolerated, but it can cause

abdominal distress, headaches, fever, fatigue, alopecia, increases in liver enzymes,

and pancytopenia. Blood counts and liver function studies should be followed

during long-term therapy

o Side effects and adverse effects include

 Dizziness, anorexia, nausea, and vomiting

 Less frequent problems are epigastric pain, abdominal cramps, diarrhea, pruritus,

headache, drowsiness, and neuropsychiatric symptoms

 Irreversible liver failure and fatal Stevens-Johnson syndrome have been reported.

STEP 6: Interaction and Precaution of Essential Antihelminthes (15

minutes)

o Interaction

 Serum levels of mebendazole may be decreased by concomitant use of

carbamazepine or phenytoin and increased by cimetidine

o Precaution

 Mebendazole should be used with caution in patients with cirrhosis

 Mebendazole is teratogenic in animals and therefore contraindicated in pregnancy.

 It should be used with caution in children younger than 2 years of age because of

limited experience and rare reports of convulsions in this age group

o Precaution

 The drug should not be given to patients with known hypersensitivity to other

benzimidazole drugs

 The drug should not be given to patients with cirrhosis.

 The safety of albendazole in pregnancy and in children younger than 2 years of

age has not been established

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o Precaution

 Much more toxic than other benzimidazole or Ivermectin, so other agents are now

preferred for most indications

 The drug should not be used in pregnancy or in the presence of hepatic or renal

disease

o Precaution

 The consumption of alcohol should be avoided on the day of treatment and for 1

day afterward

 The safety of the drug has not been established in pregnancy or for children

younger than 2 years of age

o Interaction; It is best to avoid concomitant use of Ivermectin and other drugs that

enhance GABA activity for example

 Barbiturates

 Benzodiazepines

 Valproic acid

o Precaution.

 Ivermectin should not be used in pregnancy.

 Safety in children younger than 5 years has not been established

Step 7: Key Points (5 minutes)

Albendazole, thiabendazole, Niclosamide and Ivermectin.

trimester

STEP 8: Evaluation (5 minutes)

Ask students the following questions and clarify

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References

Ministry of Health and Social Welfare. (2013). Standard Treatment Guidelines & National

Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania

government printers.

Pharmacotherapy: Aa Ppathophysiologic Aapproach (9th ed.). New York, McGraw-

Hill Education.

Sally S.R, Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed) New York,

Lippincott Williams and Wilkins.

School of Pharmaceutical sciences. (2011).Tanzania Pharmaceutical Handbook (2nd ed.).

Dar es Salaam, ARDHI University press.

The Royal Pharmaceutical Society of Great Britain. (2007). Martindale, The Extra

Pharmacopoeia (5TH ed). London, Pharmaceutical press.

The Royal Pharmaceutical Society of Great Britain. (2009). British National Formulary

(59th ed). London, BMJ Group and RPS Publishing.

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

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