Editorial

Use of anthelminthic drugs during pregnancy☆,☆☆

Treatment of trichinellosis is complex, based on the antiparasitic medication, mainly benzimidazole derivates and complementary treatment, based on the control of inflammation (non-steroid anti-inflammatories or corticosteroids), pain killer and symptomatic (antiallergic). Different studies on pharmacokinetic of antiparasitic molecules have been done. Research studies on animal model, and humans have been done, to prove their effectiveness on intestinal stage of the parasite and on the muscle larvae. Treatment should be adapted to the clinical evolutive stage of the disease (mild, moderate, acute, chronic, sequels) and it should be individualized for special categories of patients: elderly, children, pregnant women, immunocompromised hosts. Special attention should be given in case of documented outbreaks. For mild or less severe cases, the treatment options are diverse. There are authors who don’t recommend the specific treatment, as long as the disease shows a self-limited and uncomplicated evolution, while the antiparasitic treatment should be preserved only for acute, complicated and severe cases. In terms of chronic trichinellosis and sequels, there are also different opinions, considering the role of adjuvant therapy and rehabilitation.

Studies on anthelmintic activity of medicinal plants have received insufficient interest and attention from researchers despite the high incidence of helminth infections in the poorer communities of South Africa. There are only a few anthelmintic remedies available which are inadequate in terms of accessibility, affordability and probably efficacy. In this review, we reappraised the various anthelmintic studies on South African medicinal plants to highlight how much and/or how little is known. The rich botanical and medicinal plant knowledge in South Africa is an indication of the potential of discovering potent treatments against helminth diseases in both humans and livestock. A total of 115 plant species encompassing 43 families screened for their anthelmintic potential (mainly nematodes) are listed in the current review. Combretaceae and Fabaceae were the most commonly used families. Tetradenia riparia, Hypoxis colchicifolia, Apodytes dimiata and Leucosidea sericea are a few examples of the South African species that have demonstrated promising anthelmintic activity. Even though other species such as Dicerocaryum eriocarpum, Berchemia zeyheri and Acorus calamus are potent anthelmintics, caution must be exercised in administering these plant extracts because of their potential toxic effects. Besides the benefit of validating the efficacy of traditional medicines, compounds from South African medicinal plants could also provide a template for novel synthetic anthelmintics. However, the major bottleneck in exploring more South African medicinal plants for anthelmintic properties is probably the lack of a robust, rapid and reliable screening technique as well as adequate funding schemes. Perhaps, there could be more success stories via increased research outputs with the development and availability of high throughput screening methods for assessing the activity of these medicinal plants as well as their resultant bioactive compounds. In addition, accessibility of funds to acquire latest technology and motivate researchers will inevitably stimulate more studies geared toward alleviating the problems posed by helminth infections.

Los cambios fisiológicos que ocurren durante el embarazo condicionan cambios farmacocinéticos que pueden alterar la efectividad de los antimicrobianos y, además, hay que tener en cuenta el posible riesgo teratogénico y la toxicidad de estos medicamentos sobre el embrión y el feto. En general, las mujeres embarazadas son excluidas de los ensayos clínicos y hay escasa información farmacocinética respecto al uso y la dosificación adecuados de los antimicrobianos en las mujeres embarazadas. Además, la mayoría de antimicrobianos cruzan la barrera hematoplacentaria, pero los datos relacionados con su potencial teratogénico y su toxicidad fetal y neonatal también son limitados y tienen una fiabilibad variable. En este artículo se revisan las evidencias disponibles y de mayor relevancia clínica relacionadas con la farmacología de diferentes antibacterianos, antifúngicos, antivirales y antiparasitarios en las mujeres embarazadas, con un énfasis especial en los datos de toxicidad fetal.

The physiologic changes that occur during pregnancy result in pharmacokinetic changes that can alter the effectiveness of antimicrobial agents. The possible risk of teratogenic and toxic effects of antimicrobials on the fetus is an additional cause of concern. In general, pregnant women are excluded from clinical trials and there is little pharmacokinetic information on the use and proper dosing of antimicrobials in this population. Although most antimicrobials can cross the placental blood barrier, data on the potential teratogenic effects, and fetal and neonatal toxicity caused by antimicrobials are also limited and of varying reliability. This article reviews the available evidence with the greatest clinical relevance regarding the pharmacology of different antibiotic, antifungal, antiviral, and antiparasitic agents in pregnancy, with particular focus on data related to fetal toxicity.

This study screened for anthelmintic and/or antitumour bioactive compounds from Thai indigenous plants and evaluated effectiveness against three different worm species and two cancer cell lines.

Methylene chloride and methanol extracts of 32 plant species were screened for in vitro anthelmintic activity against three species of worms, the nematode Caenorhabditis elegans, the digeneans Paramphistomum epiclitum and Schistosoma mansoni (cercariae). Cytotoxicity of the extracts was evaluated against two cancer cell lines: human amelanotic melanoma (C32) and human cervical carcinoma (HeLa) by the SRB assay. Anthelmintic and anticancer activities were evaluated by the inhibiting concentration at 50% death (IC₅₀) and the selectivity index (SI) relative to human fibroblasts.

None of the extracts were active against Paramphistomum epiclitum. Plumbagin, a pure compound from Plumbago indica, had the strongest activity against Caenorhabditis elegans. The methylene chloride extract of Piper chaba fruits had the strongest activity against schistosome cercariae. Strong cytotoxicity was shown by the methylene chloride extract of Michelia champaca bark and the methanol extract of Curcuma longa rhizome against C32 and HeLa, respectively. These extracts had higher SI (>100) than positive controls in relation to either the worms or the cell lines. The methanol extract of Bouea burmanica had a slightly lower activity towards C32 cells than did Michelia champaca but had a much higher SI (>27,000).

The plant species screened in this research was recorded by several indigenous medicinal practitioners as antiparasitic, anticancer and/or related activities to the human major organ system.