Berman J D, Fleckenstein L
Walter Reed Army Institute of Research, Washington, DC.
Clin Pharmacokinet. 1991 Dec;21(6):479-93. doi: 10.2165/00003088-199121060-00007.
Infections with parasitic protozoa have always been problems for the developing world and are becoming of greater importance to the developed world in this age of easy international travel. The major human protozoal diseases are summarised with an emphasis on their presentation in normal hosts and in immunocompromised individuals and current US drug treatment recommendations are discussed. Present antiprotozoal regimens are based either on a pharmacokinetic rationale or on clinical trial and error. Regimens based on trial and error include amphotericin B against leishmaniasis and arsenic against African trypanosomiasis. Regimens which are to some extent driven by pharmacokinetic or biochemical considerations include paromomycin and metronidazole against amoebiasis, sodium stibogluconate against leishmaniasis, halofantrine and mefloquine against malaria, dihydrofolate reductase (DHFR) inhibitors against Pneumocystis carinii and toxoplasmosis and aerosolised pentamidine against P. carinii pneumonia. The majority of pharmacokinetic studies have been performed only on agents which have some therapeutic activity against other diseases of the developed world. Despite the trend toward rational treatment regimens, no studies have been performed that permit optimisation of antiprotozoal treatment regimens on the basis of clinical conditions such as renal failure.
寄生虫原生动物感染一直是发展中世界面临的问题，在当今国际旅行便捷的时代，对发达世界也变得越发重要。本文总结了主要的人类原生动物疾病，重点介绍了它们在正常宿主和免疫功能低下个体中的表现，并讨论了美国目前的药物治疗建议。目前的抗原生动物治疗方案要么基于药代动力学原理，要么基于临床试验和试错法。基于试错法的治疗方案包括用于治疗利什曼病的两性霉素B和用于治疗非洲锥虫病的砷剂。在一定程度上由药代动力学或生化因素驱动的治疗方案包括用于治疗阿米巴病的巴龙霉素和甲硝唑、用于治疗利什曼病的葡萄糖酸锑钠、用于治疗疟疾的卤泛群和甲氟喹、用于治疗卡氏肺孢子虫病和弓形虫病的二氢叶酸还原酶（DHFR）抑制剂，以及用于治疗卡氏肺孢子虫肺炎的雾化喷他脒。大多数药代动力学研究仅针对对发达世界其他疾病有一定治疗活性的药物进行。尽管有采用合理治疗方案的趋势，但尚未开展基于肾衰竭等临床状况优化抗原生动物治疗方案的研究。
