Patients planning to travel to other countries often ask physicians for information about immunizations and prevention of diarrhea and malaria. More detailed advice for travelers is available from the Centers for Disease Control and Prevention at 877-FYI-TRIP (877-394-8747) or www.cdc.gov/travel.

Many patients planning to travel seek advice about prevention of malaria. No drug is 100% effective for this indication; travelers should be told to take other protective measures as well. Malaria in pregnancy is particularly serious for both mother and fetus; prophylaxis is indicated if travel cannot be avoided. Countries with a risk of malaria are listed in the table on page 102. Some countries with endemic malaria transmission may not have malaria in the most frequently visited major cities and rural tourist resorts.

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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).

Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites. The table below lists first-choice and alternative drugs for most parasitic infections. The brand names and manufacturers of the drugs are listed in this article.

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.

Superseded--purchase updated Parasitic Infections article
Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites.

Note: Drugs for Parasitic Infections, revised and updated, is now available to both subscribers and nonsubscribers on our web site. This article, a bi-annual feature of The Medical Letter for many years, will not be published as a printed issue in 2002, but is included in the 16th edition of The Medical Letter Handbook of Antimicrobial Therapy. The handbook is now available and can be ordered by calling customer service at 1-800-211-2769.

(Superseded by the 2013 version. Click here to purchase.)
Parasitic infections are found throughout the world. With increasing travel, immigration, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites. The table lists first-choice and alternative drugs for most parasitic infections.

(Superseded by the 2013 version. Click here to purchase.)

(Superseded by the 2013 version. Click here to purchase.)

(Superseded by the 2013 version. Click here to purchase.)
Parasitic infections are found throughout the world. With increasing travel, use of immunosuppressive drugs and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites. The table that begins on the next page lists first-choice and alternative drugs for most parasitic infections. In every case, the need for treatment must be weighed against the toxicity of the drug. A decision to withhold therapy may often be correct, particularly when the drugs can cause severe adverse effects. When the first-choice drug is initially ineffective and the alternative is more hazardous, it may be prudent to try a second course of treatment with the first drug before using alternative. Adverse effects of some antiparasitic drugs are also listed, beginning on page 25.

With the deployment of hundreds of thousands of troops in Saudi Arabia, health problems endemic to the Arabian Peninsula may be coming to the attention of physicians in the USA and other areas.

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Ovide Lotion (GenDerm), 0.5% malathion in 78% alcohol, was recently approved by the US Food and Drug Administration for treatment of head lice; it is available only by prescription. A previous formulation of malathion (Prioderm Lotion - Medical Letter, 25:30, 1986) was commercially unsuccessful in the USA and was withdrawn.

(Superseded by the 2013 version. Click here to purchase.)
Parasitic Infections are now encountered throughout the world. With increasing travel, use of immunosuppressive drugs, and the spread of AIDS, physicians anywhere may see infections caused by previously unfamiliar parasites. The table on page 16 lists first-choice and alternative drugs with recommended dosages for most parasitic infections. Recommendations for treatment and prevention of malaria appear on pages 23 and 24. In every case, the need for treatment must be weighed against the toxicity of the drug. A decision to withhold therapy may often be correct, particularly when the drugs can cause severe adverse effects. When the first-choice drug is initially ineffective and the alternative is more hazardous, it may be prudent to try a second course of treatment with the first drug before using the alternative. Adverse effects of some antiparasitic drugs are listed on pages 21 and 22.