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ozoal%20drugs%20are%20a%20class,Africa%20and%20South%2DEast%20Asia.

Oral Antiprotozoal Drugs

Antiprotozoal drugs are a class of medication used to treat infections caused by protozoa, which are single cell
organisms that belong to the type of parasites. Protozoal infections occur throughout the world and are a major cause
of morbidity and mortality in some regions such as Africa and South-East Asia. Common types of protozoal
infections and associated symptoms are:

1. Malaria – it is transmitted by the bite of infected mosquitoes in tropical and subtropical areas of the world.
Symptoms include fever, chills, sweating, headache, muscle aches, vomiting and diarrhoea. The very serious
consequences of the disease are mental disturbances, convulsions and various blood and kidney disorders. These
can lead to death sometimes within 24 hours since infection.

2. Giardiasis – it is an intestinal infection, which usually found in areas with poor sanitation and
unsafe water. Infection occurs by swallowing contaminated water, by eating contaminated food or
through contact with infected person. Diarrhoea is the most common symptom of giardiasis. Other
symptoms include abdominal cramps, bloating, nausea and flatulence.

3. Trichomoniasis – it is a protozoal infection acquired through sexual contact. Females may present with vaginal
itchiness and odorous yellow vaginal discharge. Males usually do not have any symptoms, although occasionally
they may have painful urination and purulent urethral discharge.

 
 

Classes of oral antiprotozoal drugs

Commonly used oral antiprotozoal drugs can be generally classified into two main groups: antimalarial drugs and
miscellaneous antiprotozoals. In addition to their use as antiprotozoals, some of them such as metronidazole and
doxycycline are also used for treating bacterial infections.

The actions of antiprotozoal drugs against the infections are complex and are not fully understood. Some of them may
interfere with reproduction of or damage protozoal DNA to limit the spread of an infection.

Most of the oral antiprotozoal drugs are prescription-only medicines and are available in various dosage forms such as
tablets and capsules. They should only be used under close supervision by healthcare professionals.
 Antimalarial drugs
Antimalarial drugs include mefloquine, chloroquine, proguanil with atovaquone
and doxycycline. They kill or inhibit the growth of protozoa by affecting
different stage of the parasitic life cycle. They are used both to treat and
prevent malaria.

For prevention of malaria, the choice of drugs is based on the destinations

you are going to visit, the risks as determined by your travelling behaviour
and your previous health status.

For treatment of malaria, the type of antimalarial drug and the length of treatment will depend on the type of
malaria you have, the severity of your symptoms, where you caught malaria and whether you have taken an
antimalarial to prevent malaria. If you have taken an antimalarial as a preventative measure, the same type of
antimalarial should not be used to treat malaria. It is therefore important to tell your doctor which antimalarial you
have previously taken. Besides, your doctor may recommend using a combination of different antimalarial drugs to
overcome strains of malaria that have become resistant to single types of medication.

Miscellaneous antiprotozoals
Commonly used miscellaneous antiprotozoals include metronidazole, tinidazole and nifuratel. Metronidazole is the
most common treatment for trichomoniasis and giardiasis. Its action in the treatment of protozoal infections
remains poorly understood, however, it may work by damaging protozoal DNA.

Tinidazole works as well as metronidazole and has many of the same side effects, but it can be given in a single
dose. Whereas, nifuratel can be used as an alternative to metronidazole or tinidazole in the treatment of
trichomoniasis.

Common side effects and precautions of oral antiprotozoal drugs

Antiprotozoal drugs Common side effects Precautions

     

Antimalarial drugs
 
Mefloquine  Nausea and vomiting  Use with caution in patients with
 Dyspepsia epilepsy, seizures, depression or
 Abdominal pain other mental health problems,
 Diarrhoea severe heart or liver problems
 Dizziness
 Headache
 Insomnia and vivid dreams

Chloroquine  Gastrointestinal  Use with caution in patients with

disturbances neurological disorders, myasthenia
 Headache gravis (a condition with muscle
 Hypotension fatigue and weakness), glucose-6-
 Convulsions phosphate dehydrogenase (G6PD,
 Visual disturbances an enzyme which helps red blood
 Depigmentation or loss of cells function normally) deficiency,
hair liver and renal problems
 Rashes and pruritus

Proguanil with  Nausea and vomiting  Should not be given to pregnant

atovaquone  Abdominal pain or breastfeeding women
 Diarrhoea  Not recommended for patients
 Cough with severe kidney problems.
 Headache
 Dizziness
 Insomnia and abnormal
dreams
 Depression
 Anorexia
 Fever
 Skin Rash

Doxycycline  Nausea and vomiting  Should not be given to pregnant

 Diarrhoea
 Difficulty in swallowing
 Oesophageal irritation
 Cause yellow teeth and
teeth disfigurement if taken
during teeth development
or breastfeeding women and
children under 12 years
 Not recommended for patients
with kidney, liver disease
 Tablets or capsules should be
swallowed whole with plenty of
fluid and taken with food. 
Patients should not lie down for
about half an hour afterwards
 Avoid taking with antacids, milk,
calcium or magnesium salts
 Photosensitivity may occur rarely.
Avoid prolonged sunlight exposure
and use appropriate sunscreen

Miscellaneous antiprotozoals
 

Metronidazole and  Nausea and vomiting  Avoid drinking alcohol beverages

Tinidazole  Unpleasant metallic taste  Use with caution in patients with
 Furred tongue blood disorders, central nervous
 Oral mucositis system disease and severe hepatic
 Anorexia impairment
 Should not be given to pregnant
women

Nifuratel  Gastrointestinal  Should not be given to patients

disturbances with renal impairment,
 Damage to the peripheral neuropathies or G6PD deficiency
nervous system
 Easy or excessive bruising
and bleeding

 
 
 
General advice on taking oral antiprotozoal drugs
 Complete the recommended course of treatment and take the correct dose as
instructed.

 Avoiding the bite of mosquito is the first line and the best defence against contracting
malaria.  You are advised to rest in air-conditioned rooms or well-screened rooms, use
aerosol insecticide indoor and use bed nets if sleeping areas are not air-conditioned or
screened. Whilst outdoor, you are advised to wear long-sleeved shirts and trousers
and apply insect repellents containing DEET on exposed skin and clothings.

 If you are having giardiasis, you should wash

your hands regularly and avoid sharing utensils
or towels to prevent the spread of infection
among your household members.

 You are advised not to have sexual intercourse

while you are being treated for trichomoniasis
with oral antiprotozoal drugs, as you may
become reinfected.

 
  
 
Communication with your doctor

 If you are planning to travel to areas where there is a risk of

malaria, always consult your doctor early so as to assess your
need for taking antimalarial drugs, which in some cases have
to be taken at least one week before travelling.

 If you develop symptoms like those of influenza or high fever


while living in or after travelling to a high risk malaria region,
you should consult a doctor immediately.

 Antiprotozoal drugs can interact with other medicines.  Inform

your doctor of the medicines you are taking, including over-
the-counter medicines, so they can decide whether an
antiprotozoal medicine is safe for you to take.

 Inform your doctor of your medical history, as some diseases may warrant special precautionary
measures.

 Inform your doctor that you are pregnant or breast feeding as some of the oral antiprotozoal drugs should
not be taken by women who are pregnant or breast feeding.

 Seek medical advice immediately if you experience any symptoms or side effects suspected to be related
to antiprotozoal drugs.  Your doctor may review your type of medication.

 Seek medical advice if your symptoms worsen or you have any concerns about the medicines you are
taking.

 
 
 
Storage of oral antiprotozoal drugs

Oral antiprotozoal drugs should be kept in a cool and dry place. Unless specified on the label, medicines should not
be stored in refrigerators. Furthermore, drugs should be kept properly in places unreachable by children to prevent
accidental ingestion.
 
 
 
More information about travel-related protozoal diseases
Please refer to the following link for more information about travel-related protozoal diseases:

http://www.travelhealth.gov.hk/english/travel_related_diseases/travel_related_diseases.html