Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/60—Salicylic acid; Derivatives thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/60—Salicylic acid; Derivatives thereof
  • A61K31/618—Salicylic acid; Derivatives thereof having the carboxyl group in position 1 esterified, e.g. salsalate
  • A61K31/621—Salicylic acid; Derivatives thereof having the carboxyl group in position 1 esterified, e.g. salsalate having the hydroxy group in position 2 esterified, e.g. benorylate
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K33/00—Medicinal preparations containing inorganic active ingredients
  • A61K33/24—Heavy metals; Compounds thereof
  • A61K33/245—Bismuth; Compounds thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P33/00—Antiparasitic agents
• • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
  • Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
  • Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
  • Y02A50/30—Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change

Definitions

• an object of the present invention is to provide safe and effective compositions and methods for preventing and/or treating gastrointestinal disorders caused or mediated by parasitic protozoa.
• a further object of the invention is to provide such a method comprising the administration of bismuth and one or more antimicrobials.
• the present invention relates to a method for treatment of a human or lower animal subject having a gastrointestinal disorder caused or mediated by one or more parasitic protozoa comprising administering to the subject from about 50 milligrams to about 5000 milligrams of bismuth, per day, for from about 1 to 56 days; and from about 100 milligrams to about 10,000 milligrams of each of one or more antimicrobials, per day, for from about 1 to about 21 days.
• the present invention also relates to a method of prevention in a human or lower animal for a gastrointestinal disorder caused or mediated by one or more parasitic protozoa comprising administering to the subject from about 50 milligrams to about 5000 milligrams of bismuth, per day, for from about 1 to 21 days; and from about 100 milligrams to about 10,000 milligrams of each of one or more antimicrobials, per day, for from about 1 to about 14 days.
• the methods of the present invention comprise the prevention and/or treatment of gastrointestinal disorder caused or mediated by one or more parasitic protozoa. Such gastrointestinal disorders are prevented and/or treated by the administration of bismuth and one or more antimicrobials.
• the components of the present invention are more fully defined below.
• gastrointestinal disorder encompasses any infection, disease or other disorder of body, typically the upper and/or lower gastrointestinal tract, caused or mediated by one or more parasitic protozoa.
• disorders include one or more of the following conditions: diarrhea, abdominal pain and/or cramping, flatulence, nausea, abdominal distention, fever, constipation, blood, mucus and/or pus present in feces, vomiting, gastroenteritis, weight loss, anorexia, malaise, and any other condition commonly associated with infection by parasitic protozoa.
• gastrointestinal disorder also includes any condition commonly associated with protozoa infection in immunocompromised subjects and children, including but not limited to, acute diarrhea, dehydration, electrolyte imbalance, colitis, and fatal necrosis of the intestine.
• Parasitic Protozoa any condition commonly associated with protozoa infection in immunocompromised subjects and children, including but not limited to, acute diarrhea, dehydration, electrolyte imbalance, colitis, and fatal necrosis of the intestine.
• Protozoa are unicellular, eucaryotic organisms which contain a nucleus, or nuclei, and cytoplasm. Four groups of Protozoa contain parasites which are contemplated in the present invention. These organisms are fully described in Zinsser Microbiology. 20th Edition, 1992, pp. 1163-1173, and T. L. Kuhls, M.D., "Protozoal Infections of the Intestinal Tract in Children", Advances In Pediatric Infectious Diseases, vol. 8, 177- 202, (1993), both of which are incorporated herein by reference.
• parasitic protozoa refers to Protozoa of the phyla Sarcomastigophora such as Entamoeba, Giardia, Dientamoeba, and Blastocystis; Ciliophora (ciliates) such as Balantidium; Apicomplexa such as Isospora and Cryptosporidium; and Microspora such as Enterocytozoon.
• Preferred parasitic protozoa are Entamoeba, Cryptosporidium, Giardia, Isospora, and combinations thereof. Most preferred parasitic protozoa are Entamoeba, Cryptosporidium, Giardia, and combinations thereof.
• Diagnosis of gastrointestinal disorders caused or mediated by parasitic protozoa may be accomplished by any method commonly used in the medical community. Such methods are fully described in Zinsser Microbiology, and T.L. Kuhls, M.D. "Protozoal Infections of the Intestinal Tract in Children", as referenced above. Bismuth
• the methods of treatment and/or prevention in the present invention involve administration of bismuth.
• the quantity of bismuth is by weight of elemental bismuth.
• bismuth may be administered in an amount of from about 50 milligrams to about 5000 milligrams, and preferably from about 50 milligrams to about 2500 milligrams, per day, for from about 1 to about 56 days, preferably for from about 2 to about 28 days, and most preferably for from about 7 to about 21 days.
• bismuth may be administered in an amount of from about 50 milligrams to about 5000 milligrams, and preferably from about 50 milligrams to about 2500 milligrams, per day, for from about 1 to about 21 days, and preferably for from about 1 to about 14 days.
• bismuth may be administered prior to potential exposure to parasitic protozoa.
• Such administration of bismuth may vary depending on the likelihood of parasitic protozoa exposure and condition of the subject and may be commenced at any time deemed beneficial by the medical community including from about 1 to about 7 days, from about 2 to about 5 days, and from about 3 to about 4 days, prior to potential exposure.
• bismuth may be in the form of a pharmaceutically-acceptable salt or may be in the form of an organic complex which contains bismuth as an active ingredient.
• organic complexes include 2,2'-spirobi[1 ,,32-benzodoxabismole].
• bismuth is administered in the present methods as a pharmaceutically- acceptable salt.
• Such bismuth salts include bismuth aluminate, bismuth subcarbonate, bismuth subcitrate, bismuth citrate, tripotassium dicitrato bismuthate, bismuth subgallate, bismuth subnitrate, bismuth tartrate, bismuth subsalicylate, and mixtures thereof.
• Bismuth citrate, bismuth subcitrate, tripotassium dicitrato bismuthate, bismuth tartrate, bismuth subsalicylate, and mixtures thereof are preferred bismuth salts for use in this invention.
• the bismuth useful herein may be administered alone, or in combination with other pharmaceutically-acceptable components in a bismuth-containing composition.
• compositions containing bismuth salts are commercially available.
• Such compositions include DeNol, containing tripotassium dicitrato bismuthate (by Brocades); Bislumina, containing bismuth aluminate (by Mazuelos); Roter, containing bismuth subnitrate (by Roterpharma); Devrom®, containing bismuth subgallate (by The Parthenon Co., Inc.); and Pepto-Bismol®, containing bismuth subsalicylate (by The Procter & Gamble Company).
• administering refers to any method which, in sound medical practice delivers the compounds or compositions used in this invention to the subject to be treated in such a manner so as to be effective in the treatment of the gastrointestinal disorder.
• the bismuth is administered orally.
• the processes of the present invention also include administration of a safe and effective amount of one or more antimicrobials, per day.
• antimicrobial(s) refers to one or more antimicrobials.
• each of the one or more antimicrobials is administered at a level of from about 100 milligrams to about 10,000 milligrams, per day, for from about 1 to about 28 days.
• each of the one or more antimicrobials is administered at a level of from about 100 milligrams to about 8000 milligrams per day, and more preferably at from about 100 milligrams to about 5000 milligrams per day.
• each of the antimicrobials is administered for from about 1 to about 7 to 10 days, more preferably for from about 1 to about 14 days, and most preferably for from about 1 to about 21 days.
• each of the one or more antimicrobials is administered for from about 1 to about 14 days, and preferably for from about 1 to about 7 to 10 days.
• the specific dosage of antimicrobial(s) to be administered, as well as the duration of antimicrobial(s) treatment, are mutually dependent, and will also depend upon such factors as the specific antimicrobial used, the number of antimicrobials used in the treatment, the resistance pattern of the infecting organism to the antimicrobial used, the ability of the antimicrobial to reach minimum inhibitory concentrations at the site of the infection, the nature and extent of other infections (if any), the personal attributes of the subject, compliance with the treatment regimen, and the presence and severity of any side effects of the treatment. Therefore, in the case of prevention or treatment with more than one antimicrobial, the duration of administration should depend on the type of antimicrobial rather than the administration of the antimicrobials for the same number of days.
• antimicrobial refers to any naturally-occurring, synthetic or semi-synthetic compound or composition or mixture thereof, which is safe for human use as used in the methods of this invention, and is effective in killing or substantially inhibiting the parasitic protozoa when used in the methods of this invention.
• Antiprotozoal agents, antiparasitic agents and antibiotics are among the preferred antimicrobials useful herein.
• Antiprotozoal and antiparasitic agents suitable for use in the present invention include any of the agents recognized in the medical community as acceptable for treating protozoal infection.
• Such antiprotozoal and antiparasitic agents include atovaquone, chloroquine phosphate, quinacrine hydrochloride, iodoquinol, pyrimethamine, and mefloquine hydrochloride.
• Antibiotics can be generally classified by chemical composition, into the following principal groups: the aminoglycosides, such as gentamicin, neomycin, kanamycin, and streptomycin; the macrolides, such as erythromycin, clindamycin, and rifampin; the penicillins, such as penicillin G, penicillin V, ampicillin and amoxycillin; the polypeptides such as bacitracin and polymyxin; the tetracyclines such as tetracycline, chlortetracycline, oxytetracycline and doxycycline; the cephalosporins such as cephalexin and cephalothin; quinolones such as ciprofloxacin, norfloxacin and ofloxacin; and such miscellaneous antibiotics as chloramphenicol and clindamycin. These antibiotics can generally be said to function in one of four ways: inhibition of cell wall synthesis, alteration of cell wall permeability, inhibition of protein
• antimicrobials useful herein include the sulfonamides; nitrofurans, such nitrofurazon, nitrofurantoin, and furozolidone; metronidazole, tinidazole, and nimorazole. Antimicrobials among those useful herein are described in Remington's Pharmaceutical Sciences, 18th Edition, pp. 1173-1232 (1990), which is incorporated herein by reference.
• antimicrobials penicillin, erythromycin, metronidazole, doxycycline, tinidazole, amoxycillin, ampicillin, nitrofurantoin, and atovaquone are among the preferred antimicrobials for use in the present invention.
• the specific preferred quantity of antimicrobial and duration of treatment used in the methods of this invention will, in addition to other factors, depend upon the particular antimicrobial used and its pharmacology.
• the tetracyclines are preferably administered at a level of from about 100 milligrams to about 2,000 milligrams per day.
• Macrolides such as erythromycin
• Penicillins are preferably administered at a level of from about 500 milligrams to about 3,000 milligrams per day.
• the aminoglycosides are preferably administered at a level of from about 100 milligrams to about 8,000 milligrams per day.
• Nitrofurans (such as nitrofurantoin) are administered preferably at levels of from about 100 milligrams to about 800 milligrams per day.
• metronidazole is administered at a level of from about 500 to about 2,000 milligrams per day.
• atovaquone is administered at a level of from about 750 to about 2250 milligrams, per day.
• the specific method of administering the antimicrobial may depend upon such factors as the particular antimicrobial(s) used, the site of infection, the amount of antimicrobial(s) to be administered per day, the presence of any adverse side effects, and the interactions (if any) between the antimicrobial(s) and the bismuth.
• the antimicrobial(s) may be administered under the process of this invention by single daily doses, or by administration in two, three, four, or more doses per day.
• the presence of bismuth is known to adversely affect the efficacy of the tetracyclines. See, for example, C. D.
• Such methods include one or more of the following: staggered oral dosing of the bismuth and antimicrobial, through discreet administrations of each compound or composition separated by at least preferably two hours between dosages; oral administration of the antimicrobial in an enterically coated form, i.e., coating of the antimicrobial which prevents dissolution of the antimicrobial in the stomach; use of optional processes of this invention, wherein the step of administering the bismuth is terminated prior to commencing the step of orally administering the antimicrobial; and administering the antimicrobial by a non-oral route, e.g., by intravenous or intramuscular injection.
• the present invention also provides compositions for the treatment of gastrointestinal disorders comprising a safe and effective amount of bismuth and a safe and effective amount of one or more antimicrobials.
• these compositions comprise a safe and effective amount one or more antimicrobials; a safe and effective amount of bismuth; and pharmaceutically-acceptable carrier materials; wherein the safe and effective amount of the one or more antimicrobials and the bismuth is effective for preventing and/or treating a gastrointestinal disorder caused or mediated by one or more parasitic protozoa.
• a preferred composition comprises:
• the bismuth salt is present at a level of from about 50 milligrams to about 2500 milligrams.
• each of the one or more antimicrobials is present at a level of from about 100 milligrams to about 8000 milligrams.
• compositions of the present invention may contain optional components which affect the physical and therapeutic characteristics of the present compositions.
• a variety of pharmaceutically- acceptable carriers and excipients may be included, depending upon the particular dosage form to be used.
• Various oral dosage forms can be used, including such solid forms as tablets, capsules, granules and bulk powders. Tablets can be compressed, tablet triturates, enteric-coated, sugar coated, film-coated or multiple compressed, containing suitable binders, lubricants, diluents, disintegrating agents, coloring agents, flavoring agents, flow- inducing agents and melting agents.
• Liquid oral dosage forms include aqueous solutions, emulsions, suspensions, solutions, and/or suspensions reconstituted from non-effervescent granules and effervescent preparations reconstituted from effervescent granules, containing suitable solvents, preservatives, emulsifying agents, suspending agents, diluents, sweeteners, melting agents, coloring, and flavoring agents.
• a preferred composition of this invention comprises a capsule containing bismuth particles and enterically-coated antimicrobial particles.
• compositions of this invention may be used according to the methods of this invention by administering the composition from 1 to 7 times per day, and preferably from 1 to 4 times per day; for from 1 to 21 days, preferably for from about 1 to about 14 days.
• the specific frequency of administration will depend upon such factors as the specific bismuth compound or composition and antimicrobial(s) used, the levels at which the components are incorporated in the composition, the nature and severity of the condition to be treated, and the nature of any concurrent therapy, if any.
• the present invention comprises methods wherein the administration of bismuth and the administration of one or more antimicrobials are performed simultaneously (beginning and ending on the same day), concurrently (overlapping), or consecutively (sequential, but wherein the course of the treatment is substantially continuous).
• the step of administering the antimicrobial(s) is not commenced prior to commencing the step of administering bismuth.
• administering refers to any method which, in sound medical practice delivers the compounds or compositions used in this invention to the subject to be treated in such a manner so as to be effective in the treatment of the gastrointestinal disorder.
• the bismuth is administered orally.
• the antimicrobial(s) is administered either orally, intravenously, or any other method which effects systemic distribution, or local distribution to the site of the gastrointestinal disorder, of the antimicrobial(s) in the subject.
• Oral ingestion of the antimicrobial(s) is a preferred method of administering the antimicrobial(s) in the methods of this invention.
• a human subject, suffering from severe diarrhea, is treated by a method of the present invention.
• Fecal samples are taken from the subject and analyzed for the presence of intestinal parasites, including organism eggs, cysts, sporozoites, etc.
• Clinical parasitology specimens reveal the presence of Cryptosporidium parvum.
• the subject is then treated by administering a composition containing bismuth subsalicylate, sold by The Procter & Gamble Company under the name "Pepto-Bismol®".
• the composition in liquid form, is administered four times daily in equal doses delivering approximately 2500 milligrams of bismuth per day, for 21 days.
• Atovaquone tablets (750 milligrams per tablet) is concurrently administered three times a day for 21 days, delivering a total of 2250 milligrams of atovaquone per day. Thereafter, fecal samples from the subject are analyzed again, finding no trace of parasitic infection. The subject remains asymptomatic, and another fecal analysis performed 5 months later is normal.
• tripotassium dicitrato bismuthate, bismuth tartrate, bismuth citrate, and bismuth subnitrate are substituted, respectively, for bismuth subsalicylate, with substantially similar results.
• a three-year-old child with diabetes and in a day care center is suffering from chronic diarrhea, and abdominal distention.
• Analysis of fecal specimens shows the presence of Giardia lamblia.
• the infection is diagnosed and treated by orally administering approximately 400 milligrams of bismuth in the form of bismuth subcitrate ("DeNol", sold by Brocades), in four equal doses daily, for about 28 days and 100 milligrams of furolzolidone, four times daily, for about 10 days. Thereafter, fecal samples from the subject are analyzed again, finding no trace of parasitic infection.
• DeNol bismuth subcitrate
• a Peace Corps volunteer preparing to travel to a developing country with sub-standard sanitation and water purification systems has a fecal sample clinically analyzed for the presence of Giardia lamblia, Cryptosporidium parvum, and Entamoeba histolytica. Clinical results show no evidence of the parasites.
• the subject is given approximately 1200 milligrams of bismuth, (administered as bismuth subsalicylate in the composition Pepto-Bismol®, sold by The Procter & Gamble Company), in four equal doses daily, and 750 milligrams of metronidazole, three times daily, for about 21 days.
• the subject Upon return to the U.S., approximately 30 days after the initial clinical analysis, the subject remains asymptomatic. Fecal samples from the subject are analyzed and no evidence of parasitic infection is found.
• the patients are also treated by administering 750 milligrams of nitrofurantoin, per day, for 10 days. (Hence, bismuth treatment continues for 9 days after the last antimicrobial treatment). Fecal specimens are then collected from the patients and wet mount examinations are performed. There is no indication of parasitic infection.
• nitrofurazone, metronidazole, and tinidazole are substituted, respectively, for nitrofurantoin, with substantially-similar results.
• a pig farmer reports chronic abdominal pain, severe cramps, nausea, vomiting, tenesmus, and frequent watery, mucoid diarrhea.
• Examination of saline mounts of sigmoidoscopic aspirates reveal the presence of numerous ciliated trophozoites of Balantidium coli, readily recognized by their characteristic large size (50-200 micrometers), shape, and rapid rotating motion.
• the subject is treated, according to the present invention, by concurrent administration of 500 milligrams of tetracycline four times a day (for a daily total of 2 grams) and 650 milligrams of iodoquinol three times a day (for a daily total of 1850 milligrams) for 20 days.
• a composition containing tripotassium dicitrato bismuthate manufactured by Gist Brocades, and sold under the name "De-Nol" is administered four times a day (for a daily total of 480 milligrams) for 15 days.
• Sigmoidoscopic aspirates were taken following the conclusion of treatment and evaluated for parasitic presence. The specimens were normal and the patient was asymptomatic.
• bismuth citrate bismuth tartrate, bismuth subcitrate, bismuth aluminate and bismuth subsalicylate are substituted, respectively, for tripotassium dicitrato bismuthate, with substantially similar results.
• penicillin, erythromycin, metronidazole, doxycycline, tinidazole, amoxycillin, ampicillin, nitrofurantoin, and atovaquone are substituted respectively for tetracycline or iodoquinol, with substantially similar results.
• either antibiotic can be eliminated from the regimen (e.g. due to hypersensitivity) and maintain therapeutic efficacy.

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• 1996
  • 1996-05-08 EP EP96915594A patent/EP0830135A1/de not_active Withdrawn
  • 1996-05-08 WO PCT/US1996/006489 patent/WO1996035436A1/en not_active Application Discontinuation
  • 1996-05-08 AU AU57336/96A patent/AU5733696A/en not_active Abandoned
  • 1996-05-08 JP JP8534218A patent/JPH11504940A/ja active Pending
  • 1996-05-08 PE PE1996000327A patent/PE48297A1/es not_active Application Discontinuation
  • 1996-05-08 CA CA002219758A patent/CA2219758A1/en not_active Abandoned

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