Paromomycin
Sources réglementaires consultées
Indications approuvées
- Traitement de l'amibiase intestinale aiguë et chronique non invasive chez l'enfant et l'adulte.
- Traitement et prophylaxie de l'encéphalopathie portosystémique chez l'adulte.
Contre-indications
Absolues
- Hypersensibilité à la paromomycine, aux autres aminosides ou aux excipients ; constipation, iléus paralytique ou obstruction intestinale ; lésion vestibulaire ou cochléaire antérieure ; myasthénie grave ; grossesse et allaitement.
Mises en garde cliniques
- Mise en garde majeure · Bien que l'absorption orale soit habituellement minimale, des lésions gastro-intestinales ulcéreuses peuvent l'augmenter et accroître le risque de néphrotoxicité et d'ototoxicité ; surveiller les fonctions rénale et auditive. — AEMPS CIMA, Humatin, ficha técnica 36795, sección 4.4
- Mise en garde majeure · Les aminosides peuvent provoquer un blocage neuromusculaire ; utiliser avec prudence en cas de troubles musculaires et avec des bloqueurs neuromusculaires ou des anesthésiques. — AEMPS CIMA, Humatin, ficha técnica 36795, sección 4.4
Interactions médicamenteuses
- ModéréeMéthotrexate
Mécanisme: La paromomycine peut réduire significativement l'absorption du méthotrexate.
Recommandation: Éviter ou surveiller étroitement l’efficacité du méthotrexate.
https://cima.aemps.es/cima/dochtml/ft/36795/FT_36795.html
- SévèreMédicaments néphrotoxiques ou ototoxiques
Mécanisme: Une néphrotoxicité et une ototoxicité additives peuvent survenir.
Recommandation: Éviter l’utilisation concomitante si possible; surveiller les fonctions rénale et auditive si elle est inévitable.
https://cima.aemps.es/cima/dochtml/ft/36795/FT_36795.html
- SévèreBloqueurs neuromusculaires et anesthésiques
Mécanisme: Les aminosides peuvent potentialiser le blocage neuromusculaire.
Recommandation: Éviter ou utiliser avec une surveillance respiratoire et neuromusculaire étroite.
https://cima.aemps.es/cima/dochtml/ft/36795/FT_36795.html
Effets indésirables
Communs (≥1%)
Selles molles · Diarrhée · Nausées · Douleur abdominale
Rares mais graves
Néphrotoxicité · Ototoxicité · Blocage neuromusculaire · Pancréatite
Grossesse et allaitement
Ne pas utiliser pendant la grossesse ni l'allaitement. Les aminosides traversent le placenta et une embryotoxicité ou tératogénicité ne peut être exclue ; aucune donnée d'excrétion dans le lait n'est disponible pour la paromomycine.
Bibliographie récente (PubMed)
Amoebiasis, caused by Entamoeba histolytica, remains a major public health issue, particularly in developing countries with poor sanitation. It is also a significant challenge among those who travel to endemic areas, causing, in many cases, so-called traveler diarrhea. Approximately 10 percent of the global population is estimated to be affected by this parasitic infection. The primary route of transmission is the consumption of food or water contaminated with E. histolytica cysts. While most infected individuals may remain asymptomatic, some develop severe complications, including hemorrhagic colitis, liver abscesses, and, in extreme cases, colonic perforation. It has been estimated that amoebiasis is responsible for nearly 100,000 deaths annually. Standard treatment for amoebic colitis involves a combination of luminal agents (such as paromomycin, diloxanide furoate, and diiodohydroxyquin) and tissue amoebicides (including metronidazole and tinidazole). Although these treatments are effective, new therapeutic options to improve patient outcomes are needed. One promising avenue for drug discovery is the β-carbonic anhydrase enzyme (EhiCA) of E. histolytica, which has emerged as a potential target for novel antiamoebic therapies. EhiCA was recently produced as a recombinant protein and has been used in kinetic and inhibition studies with various sulfonamides and anions, with promising results.
Over the past 20 years, significant progress has been made in anti-leishmanial therapy. Three new drugs/formulations are available for the treatment of various forms of leishmaniasis, namely oral miltefosine, paromomycin and liposomal amphotericin B. However, these advances in drug development have added considerable complexity for clinicians including toxicity, emergence of resistance and decreased sensitivity of available drugs. The development of newer drugs with less toxicity and more efficacy is urgently needed. This review comprehensively examines the latest developments and current status of antileishmanial drugs for the treatment of leishmaniasis across the world. Several new investigational drugs that showed anti-leishmanial activity under in vitro or in vivo conditions and either underwent the phase-I/II clinical trials or are on the verge of entering the trials were reviewed. We also delve into the challenges of drug resistance and discuss the emergence of new and effective antileishmanial compounds. The available treatments for leishmaniasis are limited in number, toxic, expensive, and demand extensive healthcare resources. Every available antileishmanial drug is associated with several disadvantages, such as drug resistance and toxicity or high cost. Miltefosine is potentially teratogenic. New antileishmanial drugs/treatment modalities are sorely needed for expanding future treatment options.
Despite their clinical importance, saving numerous human lifes, over- and mis-uses of antibiotics have created a strong selective pressure on bacteria, which induces the emergence of (multi)resistant strains. Antibioresistance is becoming so pregnant that since 2017, WHO lists bacteria threatening most human health (AWaRe, ESKAPE lists), and those for which new antibiotics are urgently needed. Since the century turn, this context is leading to a burst in the chemical synthesis of new antibiotics, mostly derived from natural antibiotics. Among them, aminoglycosides, and especially the neomycin family, exhibit broad spectrum of activity and remain clinically useful drugs. Therefore, numerous endeavours have been undertaken to modify aminoglycosides with the aim of overcoming bacterial resistances. After having replaced antibiotic discovery into an historical perspective, briefly surveyed the aminoglycoside mode of action and the associated resistance mechanisms, this review emphasized the chemical syntheses performed on the neomycin family and the corresponding structure activity relationships in order to reveal the really efficient modifications able to convert neomycin and its analogues into future drugs. This review would help researchers to strategically design novel aminoglycoside derivatives for the development of clinically viable drug candidates.
Dientamoeba fragilis is a protozoan of the gastrointestinal tract, very prevalent in our environment and responsible for diverse clinical symptoms mainly abdominal pain, diarrhoea and eosinophilia, although some infected patients are asymptomatic. Since the first description just a century ago, there are many unanswered questions: its different morphologies and the role of each of them, its actual prevalence, the mode of transmission, its pathogenicity, or the treatment of choice, continue to be source of controversy. Risk factors associated with infection by D. fragilis are: contact with children, residence in a rural area, and co-infection by Enterobius vermicularis. New molecular diagnostic techniques in the form of commercial multi-diagnostic panels are now considered first choice techniques. Paromomycin show higher cure rates, than metronidazole.