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Kala Azar and Filariasis: Treatment and Mechanisms

Classification of Drugs Used in Kala Azar

1. Antimonials (Sodium Stibogluconate)

  • Mechanism of Action: Inhibits parasite metabolism by interfering with energy production.
  • Adverse Effects: Hepatotoxicity, nephrotoxicity, ECG changes.
  • Contraindications: Liver or kidney dysfunction.

2. Amphotericin B

  • Mechanism of Action: Binds to ergosterol in the parasite's membrane.
  • Adverse Effects: Nephrotoxicity, fever, chills, electrolyte imbalance.
  • Contraindications: Renal failure, nephrotoxic drugs.

3. Miltefosine

  • Mechanism of Action: Inhibits phospholipid metabolism.
  • Adverse Effects: Nausea, vomiting, liver dysfunction, teratogenicity.
  • Contraindications: Pregnancy and breastfeeding.

4. Paromomycin

  • Mechanism of Action: Inhibits protein synthesis by binding to the ribosome.
  • Adverse Effects: Hearing loss, nephrotoxicity, allergic reactions.
  • Contraindications: Hearing loss, renal dysfunction.

Classification of Drugs Used in Filariasis

1. Diethylcarbamazine (DEC)

  • Mechanism of Action: Targets microfilariae and adult worms.
  • Adverse Effects: Fever, rashes, dizziness.
  • Contraindications: Strongyloidiasis.

2. Albendazole

  • Mechanism of Action: Inhibits microtubule formation.
  • Adverse Effects: Gastrointestinal upset, hepatotoxicity.
  • Contraindications: Pregnancy (especially first trimester).

3. Ivermectin

  • Mechanism of Action: Paralyzes the parasite through chloride channel binding.
  • Adverse Effects: Fever, pruritus, lymphadenopathy.
  • Contraindications: Pregnancy, children under 5 years.

Treatment of Kala Azar

  • First-line treatment: Sodium Stibogluconate or Meglumine antimoniate (20-day regimen).
  • Alternative treatments: Amphotericin B (liposomal), Miltefosine, Paromomycin.

Treatment of Filariasis

  • Microfilarial treatment: Diethylcarbamazine (DEC), Albendazole, or Ivermectin.
  • Adult worm treatment: Combination of DEC with Albendazole or Ivermectin.
  • Lymphatic damage management: Antibiotics for secondary infections, hygiene practices.