With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by parasites. The table in this document lists first-choice and alternative drugs for most parasitic infections.

Artesunate for injection (Amivas LLC), a semi-synthetic artemisinin derivative, is now approved by the FDA for initial (induction) treatment of severe malaria in children and adults. It has been available from the CDC on a compassionate use basis since 2007. Artemether/lumefantrine (Coartem), another artemisinin-based drug, was approved earlier for oral treatment of uncomplicated Plasmodium falciparum malaria. IV artesunate is now the only FDA-approved injectable antimalarial drug available in the US; IV quinidine has been discontinued.

The FDA has approved artemether-lumefantrine (Coartem - Novartis) for oral treatment of uncomplicated Plasmodium falciparum malaria. It is not approved for prophylaxis. Artemether-lumefantrine is the first artemisinin-based drug approved for use in the US. Artemisinins are Chinese herbal products used worldwide to treat malaria. The intravenous formulation of artesunate, another artemisinin, is available in the US through the CDC.

Nitazoxanide (Alinia - Romark Labs), a new antiparasitic drug, has been approved by the FDA in a liquid formulation for treatment of diarrhea caused by Cryptosporidium parvum and Giardia lamblia in children 1 to 11 years old. It is the first drug approved for treatment of cryptosporidiosis and the first to become available as a liquid for treatment of giardiasis. The FDA is reviewing a tablet formulation of nitazoxanide for use in adults.

Cytomegalovirus immune globulin (CMVIG) for intravenous administration is now available in the USA on an investigational basis (FE Young and SL Nightingale, JAMA, 260:224, July 8, 1988) for prevention of cytomegalovirus (CMV) infection in CMV-seronegative renal transplant recipients who receive a kidney from a seropositive donor. CMVIG contains IgG antibodies from a pool of healthy donors with high titers of antibodies against CMV. The drug can be obtained from the Massachusetts Department of Public Health Biologic Laboratories (617-522-3700, extension 264) or the American Red Cross...

The oral antimalarial tafenoquine succinate, a long-acting analog of primaquine, has been approved by the FDA in 2 different strengths. Arakoda (100-mg tablets; Sixty Degrees) is indicated for the prophylaxis of malaria in adults. Krintafel (150-mg tablets; GSK) is indicated for the prevention of relapse (radical cure) of Plasmodium vivax malaria in patients ≥16 years old undergoing treatment for acute P. vivax infection.

A fixed-dose combination of atovaquone and proguanil hydrochloride has been approved by the FDA for oral prophylaxis and treatment of malaria due to Plasmodium falciparum, including choloroquine-resistant strains.

The CDC recently announced that it will now supply the investigational drug miltefosine (Impavido – Paladin, Canada) for treatment of infections caused by free-living amebae.1 The drug was previously available in the US only from the manufacturer through an FDA Investigational New Drug (IND) application.Meningoencephalitis caused by the free-living amebae Naegleria fowleri, Acanthamoeba spp., or Balamuthia mandrillaris, usually acquired through the nose while swimming in warm fresh water, has a mortality rate of >90% despite treatment with multiple antimicrobial drugs.2 Miltefosine is...

The FDA has approved miltefosine (Impavido – Knight Therapeutics), an oral alkylphosphocholine analog, for treatment of visceral, cutaneous, and mucosal leishmaniasis caused by some Leishmania species. It is the first drug to be approved by the FDA for treatment of cutaneous and mucosal leishmaniasis and the first oral drug to be approved for treatment of visceral leishmaniasis.

Tinidazole (Tindamax - Presutti Labs), an oral antiprotozoal drug similar to metronidazole (Flagyl, and others), has been approved by the FDA for treatment of trichomoniasis in adults and for treatment of giardiasis, intestinal amebiasis and amebic liver abcess in adults and children more than 3 years old. Tinidazole has been widely used outside of the US for decades under the trade name Fasigyn (Pfizer).