Paromomycin Sulfate and Phenytoin Sodium

• Generic Name: paromomycin
• Dosage Forms: n.a.
• Other Brand Names: Humatin, Paromycin

Treatment of acute and chronic intestinal amebiasis caused by Entamoeba histolytica.

Treatment of asymptomatic cyst passers (intraluminal infections), especially in children and pregnant women.

Not effective for and should not be used alone for treatment of extraintestinal amebiasis (including amebic liver abscess) caused by E. histolytica. Used to eradicate encysted E. histolytica in the intestinal lumen as follow-up after treatment with a tissue amebicide (metronidazole or tinidazole).

Treatment of mild to moderate or severe symptomatic intestinal amebiasis or extraintestinal disease (including amebic liver abscess) involves the use of both a tissue and a luminal amebicide to ensure eradication of tissue-invading trophozoites as well as cysts in the intestinal lumen.

Regimen of choice for symptomatic intestinal amebiasis or extraintestinal disease (including liver abscess) is a nitroimidazole derivative (oral metronidazole or oral tinidazole) followed by a luminal amebicide (oral iodoquinol or oral paromomycin).

Some strains of Entamoeba are nonpathogenic (e.g., E. dispar, E. hartmanni) and asymptomatic intraluminal infections with these organisms generally do not require treatment.

Has been used for treatment of balantidiasis caused by Balantidium coli.

Not a drug of choice. Tetracycline is the drug of choice and metronidazole and iodoquinol are alternatives for treatment of balantidiasis.

Has been used for treatment of cestodiasis (tapeworm infection) caused by certain cestodes pathogenic to humans including Diphyllobothrium latum (fish tapeworm), Dipylidium caninum (dog and cat tapeworm), Hymenolepis nana (dwarf tapeworm), Taenia saginata (beef tapeworm), and T. solium (pork tapeworm).

Not a drug of choice. Praziquantel, niclosamide (not commercially available in the US), and nitazoxanide usually recommended for treatment of these tapeworm infections.

Treatment of cryptosporidiosis caused by Cryptosporidium parvum in patients with HIV infection; used alone or in conjunction with azithromycin.

No anti-infective has been found to reliably eradicate Cryptosporidium, although several drugs (e.g., paromomycin, azithromycin, nitazoxanide) appear to suppress the infection.

CDC, NIH, IDSA, and others state that the most appropriate treatment for cryptosporidiosis in HIV-infected individuals is the use of potent antiretroviral agents (to restore immune function) and symptomatic treatment of diarrhea.

Treatment of infections caused by Dientamoeba fragilis.

Iodoquinol, paromomycin, tetracycline, or metronidazole are drugs of choice for treatment of D. fragilis infections.

Treatment of giardiasis caused by Giardia duodenalis (also known as G. lamblia or G. intestinalis).

Drugs of choice are metronidazole, tinidazole, or nitazoxanide; alternatives are paromomycin (especially in pregnant women), furazolidone (not commercially available in the US), or quinacrine (not commercially available in the US).

Although paromomycin may be less effective than the other agents, it is poorly absorbed from the GI tract and may be useful for treatment of giardiasis in pregnant women.

Has been used in the management of hepatic coma as an adjunct to protein restriction and supportive therapy to inhibit nitrogen-forming bacteria in the GI tract.

Not a preferred or alternative treatment; nonabsorbable disaccharides (lactulose) or certain other anti-infectives (neomycin or metronidazole) usually recommended.

Has been used topically (in conjunction with topical methylbenzethonium chloride) for treatment of cutaneous leishmaniasis, including infections caused by Leishmania major, L. braziliensis, and L. mexicana.

Has been used IM for treatment of visceral leishmaniasis (kala azar) caused by L. donovani.

For treatment of cutaneous leishmaniasis, pentavalent antimony compounds (IM or IV sodium stibogluconate or meglumine antimonate [drugs not commercially available in the US]) are drugs of choice; topical paromomycin or IM or IV pentamidine are alternatives.

For treatment of visceral leishmaniasis, pentavalent antimony compounds (e.g., IM or IV sodium stibogluconate or meglumine antimonate [drugs not commercially available in the US]) or IV amphotericin B (conventional or liposomal) are drugs of choice; IM or IV pentamidine or IM paromomycin are alternatives.

Topical paromomycin should be used only in geographic regions where cutaneous Leishmania species have low potential for mucosal spread. Topical treatment cannot cure lymph node infection or protect against mucosal disease if metastasis has already started.

• Generic Name: phenytoin
• Dosage Forms: injection, solution
• Other Brand Names: Dilantin, Dilantin Infatabs, Phenytek, Phenytoin Sodium, Prompt

Management of generalized tonic-clonic (grand mal) seizures.

Management of partial seizures with complex symptomatology (psychomotor and temporal lobe seizures).

Not recommended for treatment of pure absence (petit mal) seizures since the drug may increase frequency of these seizures, but may be used in conjunction with other anticonvulsants when mixed seizure types are present.

Prevention and treatment of seizures occurring during and following neurosurgery.

Used IV for treatment of status epilepticus; however, use may be limited by its slow onset of action and need for slow administration.

Benzodiazepines (e.g., diazepam, lorazepam, midazolam) are considered drugs of choice for initial treatment of status epilepticus; IV phenytoin (or fosphenytoin) may be used as a second-line agent if seizures continue.

Concurrent administration with an IV benzodiazepine or short-acting barbiturate will usually be necessary for rapid control of seizures.

Fosphenytoin appears to be better tolerated than phenytoin, and some experts state that fosphenytoin is preferred when both drugs are available.

Has been used IV for treatment of cardiac arrhythmias, particularly ventricular arrhythmias, in patients who do not respond to conventional antiarrhythmic agents or cardioversion. However, current use as an antiarrhythmic agent is limited by the drug's narrow therapeutic window, multiple drug interactions, and adverse effect profile.

Has been used IV for treatment of arrhythmias caused by cardiac glycoside intoxication, especially in the presence of AV block, because the drug improves conduction through the AV node.