Pentamidine and Sodium Stibogluconate

Pentamidine:

It interacts with the kinetoplast DNA, suppresses topoisomerase II, or obstructs aerobic glycolysis and polyamine consumption.

Indication:

• Kala-azar
• Pneumocystis jiroveci pneumonia
• Trypanosomiasis

Dose:

• Visceral leishmaniasis:
  • 4mg/kg IM or slow IV for 5-25 weeks on alternate days.

Contraindication:

• Renal impairment that is severe.

Side effect:

• Nephrotoxicity, vomiting, tachycardia, arrhythmias, collapse, fainting, syncope, hypotension, cardiovascular confusion, dyspnoea, hypocalcemia, pancreatitis, liver damage.

Nursing consideration:

• Pentamidine is administered intramuscularly (IM) into a big muscle after dissolving the contents of 1 vial (300 mg) in 3 ml of sterile water.
• Dissolve contents of 1 vial in 3–5 mi of sterile water for injection or DS for IV infusion. More dilution in 50–250 mL of D5 should be given over 60 minutes.
• closely and frequently monitor breathing, pulse, and blood pressure. After a single dose, sudden, severe hypotension may start to occur. While receiving the medication, position the patient to be supine.
• A periodic ECG check should be done before and during treatment. Cardiotoxicity, tachycardia, and cardiac arrhythmias could result from it.
• When taking pentamidine, regular potassium monitoring is advised. Most nephrotoxicity is mild to moderate and does not call for stopping the medicine.
• Use cautiously in anemia, blood dyscrasias, hepatic or renal disease, hypoglycemia,diabetes mellitus,ventricular tachycardia, hypocalcemia, hypertension, pregnant or breastfeeding patients.

Sodium Stibogluconate:

It is kala-medicine azar's of choice. You must administer this medication parenterally.

Mechanism of action:

• It prevents the processes for fatty acid oxydation and glycolysis.
• In turn, this encourages the outflow of glutathione and other reduced thiols from the parasite, exposing it to oxidative harm. Antimony of Sodium Stibogluconate converts antimony to hazardous trivalent form.

Indication:

• Except for Leishmania aethiopica infection, pentavalent antimony, also known as sodium stibogluconate or meglamine antimonate, is the preferred treatment for leishmaniasis.

Dose:

• 20 mg/kg 28 days (route as IM or slow IV given at least over 5 minutes)

Contraindication:

• Severe liver, kidney, and heart problems.

Side effect:

• Nausea, vomiting, metallic teste, cough, pancreatitis, abdominal pain, liver damage. renal damage. ECG abnormalities, IM injection can be painful and IV administration may cause thrombophlebitis

Nursing consideration:

• Before and during the course of the therapy, keep an eye on the patient's levels of serum calcium, sodium, potassium, bicarbonate, serum osmolarity, acid-base balance, and renal function.
• A full glass of water should be consumed along with the tablet.
• Route intravenous (IV) or intramuscular (IM) at district level and above, respectively, and intramuscular (IM) at peripheral level, that is, below district.
• Stop the IV injection if the patient starts coughing or experiences back pain.
• 20 days; if there is a partial response after 20 days, extend the treatment for up to 30 days.
• At 20 or 30 days, depending on the situation, check the splenic or bone marrow swab for parasite burden.