Mini Case 5:

Drug Pool
Case:
Wayne Winston, a 45 y/o male septic tank
siphoning employee, had mild watery diarrhea
for six weeks. His symptoms included crampy
abdominal pain, occasional low grade fever, and
watery, frothy stool that sometimes was blood-
tinged. He experiences vague abdominal
discomfort prior to having loose bowel
movements two to three times a day. He claims
to have had lost weight since the onset of his
symptoms. Due to the persistence of symptoms,
he decided to consult your clinic.
Case
PE reveals vague lower abdominal tenderness. His
weight is now 52 kg from the previous 55 kg before
the onset of his symptoms.

Lab results show presence of E. histolytica cysts and

trophozoites on fecalysis.

In your prescription, you write the generic

preparation/s but indicate particular brand/s that
your friendly drug representative details in your
clinic
What clinical syndrome did
Wayne Wilson present with?
Wayne Wilson presented
with a parasitic infection
called Amebiasis
What drug measures
would you advise Wayne?
• Adequate rehydration
Make a list of the drug/s that you can consider in
a patient with similar clinical presentation as
Wayne. Include their MOA:
• Metronidazole (followed by luminal agent
such as paromomycin to eliminate
intraluminal cysts) (meron pa nito pero di
ko gets handwriting ni gian

• Inhibits nucleic acid synthesis by disrupting

the DNA of microbial cells, mostly on
anaerobes
• Tinidazole (can be alternative if better
tolerated)
• Also interferes with genetic material of
bacteria
What drug/s can you give for the definitive
management of Wayne’s condition. Give a short
explanation based on the ESSC cirteria
Drug of Choice E S S C
Metronidazole MOA: Inhibits ADR: CI: Dosage:
nucleic acid Renal and hypersensitivity Oral, suspension
synthesis hepatic Chronic alcohol
impairment dependence
CHF And px taking
disulfiram
Tinidazole MOA: interferes ADR: CI: Dosage:
with DNA Anorexia, Hypersensitivity Oral with food
synthesis constipation, pregnancy intake
dizziness,
dysgeusia,
dyspepsia,
headache,
nausea, vomiting
malaise
What advice can you give Wayne
when he returns to work?
• Improve his hygiene practices to limit fecal-oral spread
o f enteric pathogens
• Due to nature of work, consider taking prophylactic
antimicrobial agents before returning to work