1. BY
SV.VIVEK

2. Cestodes
Nematodes
Trematodes
Helminthes

3. Anthelmintics
Vermicide
Vermifuge

5. Mebendazole

6. Benzimidazole ,
Broad spectrum activity ,
It produced nearly 100% cure rates in egg counts
in roundworms , hookworms ,
enterobius , trichuris infestation .
But H.Nana is insensitivity .

7. Mech. Of Action
Blocks glucose uptake
Binds with β tubulin & inhibits
microtubules polymerization

8. Minimal intestinal absorption
75 – 90 % of an oral dose is passed in the faeces
First pass metabolism
Pk

9. Adverse effect
• Diarrhoea ,
• Nausea ,
• Abd. Pain .
In heavy infestation cases,
• Granulocytopenia ,
• Allergic reaction ,
• Loss of hair .
In high dose,
• Expulsion of ascaris – mouth & nose .
Due to starvation & slow death,

10. USES…

11. • 100 mg BD x 3 daysRound worms
Ascaris lumbricoides
• 100 mg BD x 3 daysHook worm
Ancylocystoma duodenale
Necator americanus
• 100 mg OD x 2-3 wksThread worm
Enterobius vermicularis
• 100 mg BD x 3 daysWhip worm
Trichuris trichura
As first choice of drug…

12. As Alternative drug…
• 200 mg BD x 4 days
Whipworm
Trichinella sprialis
• 200-400 mg BD/TDS x 3-4 wk
Dog tapeworm
Hydatid disease

13. Albendazole

14. Congener of mebendazole
One dose treatment has cure rates in ascariasis, hook
worm, enterobius
3 day treatment has cure rate in H.nana
MOA – similar to mebendazole

15. PK
Moderate oral administration
Widely distributed in body
It enters brain
First pass metabolism
Excreted in urine
T½ - 8.5 hrs
Along with fatty meals,  absorbtion

16. Adv. effects
Well tolerated
G.I. side effects
Dizziness
Prolonged use in hydatid & cysticercosis –
headache, fever, alopecia, neutropenia, jaundice
C/I
 Occular cysticercosis

17. Uses…

18. • 400 mg single dose(adults)
• 200 mg single dose(1-2 yrs)
Round worms
Ascaris lumbricoides
• 400 mg single dose(adults)
• 200 mg single dose(1-2 yrs)
Hook worm
Ancylocystoma duodenale
Necator americanus
• 400 mg single dose(adults)
• 200 mg single dose(1-2 yrs)
Thread worm
Enterobius vermicularis
As first choice of drug…

19. • 400 mg OD x 3 daysWhipworm
Trichinella spiralis
• 400 mg BD x 8-15 days
• Paed. Dose -15 mg/kg/day
Tapeworm
Neurocysticercosis
• 400 mg BD x 4 wks
• Repeat 2-3 wks if requried
• Upto 3 courses
Dog tapeworm
hydatid disease

20. As Alternative drug…
Thread worm-Strongyloides stercoralis
400 mg single dose(adults) & 200 mg single dose(1-2 yrs)
Whipworm-Trichuris trichura
400 mg single dose(adults) & 200 mg single dose(1-2 yrs)
Filariasis
Tapeworm
Taenia saginata,taenia solium

21. THIOBENDAZOLE

22. First benzimidazole polyanthelmintic
It inhibits development of eggs of worms & kills larvae
It has analgesic,antiinflammatory & antipyretic action
MOA-similar as mebendazole
PK-well absorbed from GI tract
Adv. eff.-nausea,vomiting,loss of appetite,giddiness,
itching,abd. pain,diarrhoea

23. USES…
Symptomatic relief in
 Cutaneous larvae migrans
 Guinea worm disease
In Strongyloidosis & Trichinosis
DOSE:
 25 mg/kg/day – 2 divided dose - after meals
 Chewable tablets

24. Pyrantel
Pamoate

25.  It was introduced for thread worm infestation in children ;
use soon extend to roundworm , hook worm.
 It inactive against trichuris & other worms.
 Piperazine antagonizes the action of pyrantel Pamoate.
Pk - 10-15% of an oral dose is absorbed.
Adv. Effects – G.I symptoms, headache,
dizziness, tasteless .

26. Mech. Of Action
Contracture & Spastic Paralysis of worm
Persistant Depolarization
Activation of nicotinic cholinergic receptors in worm

27. USES…

28. • Singledose of 10mg/kg is
required
Round worm
Ascaris lumbricoides
• Singledose of 10mg/kg is
required
Hook worm
Ancylocstoma
duodenale
• Singledose of 10mg/kg
is required
Thread worm
Enterobius
vermicularis
AS FIRST CHOICE OF DRUG,

29. PIPERAZINE

30. It highly active drugs against ascaris ,
enterobius .
It safe during Pregnancy .
Mech. Of action
Flaccid paralysis & Expels alive worms
Hyperpolarization & Relaxation of ascaris muscle
Gaba agonistic action openning cl- channels

31. Pk
 Moderate oral absorption ,
 Partly metabolized in liver & excreted in urine .
Adv. Effects
 Nausea, vomiting, abd. Discomfort, utricaria
 High dose – dizziness, excitement
 Toxic dose – convulsions, paralysis due to
Resp. failure
C/I
 Renal insufficiency , epileptics .

32. Uses…
As second choice of drug ,
• 4g OD x 2 day(A)
• 0.75g/years of age(C)
Round worm
Ascaris
lumbricoides
• 50 mg/kg OD x 7 Days
Thread worm
Enterobius
vermicularis

33. Levamisole &
Tetramisole

34. Both are active against many nematodes , but use
is restricted to ascariasis & ancylocystomiasis.
Mech. Of action
 Ganglia in worms are stimulated causing tonic
paralysis & expulsion of live worms .
 Interfere with carbohydrate metabolism –
inhibition of fumarate reductase also contributing .
 Nausea, Abd. Pain, gudiness, fatigue .
Adv. effects

35. Uses...
As second choice of drug,
Round worm – Ascaris lumbricoides
• Single dose - 50mg ( C )
Hook worm – Ancylocystoma duodenale
• Single dose – 150mg ( A )

36. Diethyl Carbamazine
Citrate
[ DEC]

37. It is the 1st drug for fillariasis .
It highly selective effect on microfilariae .
Pk
Well oral absorption
Widely distributed in the body
Metabolized in liver & excreted in urine
Plasma t½ - 4 -12 hrs

38. Mech. Of action
• Alternation of Mf membrane
Phagocytosed by tissue fixed monocytes
• But not by circulating phagocytes.
• Affect muscular activity and cause
hyperpolarisation due to piperazine
moiety.

39. Adv. effects
Nausea, headache, loss of appetite, weakness,
dizziness .
Febile reaction with rash, lymphnode enlargement,
Bp .
 leukocytosis , mild albiminuria .

40. Uses …
Filariasis – Wucharia bancrofti
• 2mg/kg TDS – Rapid symptomatic Relief
Tropical eosinophilia
• 2 – 4mg/kg TDS x 2-3 wks
Loa loa & o.volvulus – but it give 25-
50mg test dose to avoid severe
reations to dying .

41. Ivermecti
n

42. Potent semisynthetic derivative
Obtained from Streptomyces avermitilis
Mech. Of action
Tonic paralysis
Acts via glutamate gated Cl˜ channels

43. PK
 Orally absorbed
 Wide distribution
 T½ - 2-3 days
Adv. Eff.
 Pruritis
 Nausea
 Abd. Pain
 Constipation
 Lethargy
 Transient ECG changes

44. USES…
Thread worm-Strongyloides stercoralis
Filaria-Wucheria bancroftia
Cutaneous larvae migrans & River Blindness
ascariasis
Scabies & pediculosis – In orally

45. Praziquantel

46. Novel anthelmintic
Active against Schistosomes ,Trematodes & Cestodes
Mech. Of action
worm loses its grip in git & expelled out
Contracture & Paralysis
Acts by causing leakage of IC Ca from the membrane

47. PK
 Rapidly absorbed from intestine , T½ - 1.5 hours
 First pass metabolism , excreted in urine
 Along with food, absorbtion
 Enzyme inducers - metabolism
Adv. Eff.
 No systemic toxicity
 Bitter in taste – nausea & abd. Pain
 Head ache, dizziness & sedation
 rashes, urticaria, fever, itching & body pain
C/I - Occular cysticercosis

48. USES…. • T.saginata,T.solium-10 mg/kg single dose in
morning
• H.nana,D.latum-15-25 mg/kg single dose in
morning
• In heavy infestation, retreatment aft. a week
is desirable
Tapeworm
• First to be effective-2nd drug of choice
• 50-100 mg/kg daily in 3 doses x 15 days
Neurocysticercosis
• 40-75 mg/kg once as single/divided
dose
Schistosomes
• DOC for fluke infestations except Fasciola
hepatica
• 75 mg/kg/day x one/two days
Others flukes

49. NICLOSAMIDE

50.  It effective against cestodes infesting man –
T.saginata , T.sollium , D.latum , H.nana , thread
worm .
 It safe during pregnancy
Mech. Of action
Cause injury & partly digested in the intestine
Interfere with anaerobic generation of ATP by the tapeworm
Inhibit oxydative phosphorylation in mitochondria

51. Adv. effects
 Tasteless & non irritating
 No systemic toxicity
 Minor abd. Symptoms
 Malaise, pruritis, light headedness
Uses
 As 1st line drug – T.saginata
 As 2nd line drug – T.sollium

52. Treatment of
Neurocysticercosis

53.  Causative agent: T.solium
 Due to: migration of larvae from gut to various tissue via
blood stream.
 On anthelmintic treatment ,the larvae dies and its
product induce an intense focal reaction results in
seizures and other neurological symptoms.
 Treatment :
 Albendazole and Praziquantel.
 Corticosteroids
 Anti-convulsants.

54. Advantages of albendazole over praziquantel
 Short course of treatment
 High cure rate
 Corticosteroiods enhances the absorption of albendazole.
 Albendazole is cheaper.