Registered for human use in 1987, ivermectin was immediately donated as Mectizan tablets to be used solely to control Onchocerciasis, a skin disfiguring and blinding disease caused by infection with the filarial worm Onchocerca volvulus, which afflicted millions of poor families throughout the tropics. Marketed in 1981, it quickly became used worldwide to combat filarial and other infections and infestations in livestock and pets. It proved to be extremely effective against most common intestinal worms (except tapeworms), could be administered orally, topically or parentally and showed no signs of cross-resistance with other commonly used anti-parasitic compounds. It had a broad spectrum of activity, was highly efficacious, acting robustly at low doses against a wide variety of nematode, insect and acarine parasites. 15, 16, 17 Ivermectin is a safer, more potent semisynthetic mixture of two chemically modified avermectins, comprising 80% of 22,23-dihydroavermectin-B1a and 20% 22,23-dihydroavermectin-B1b ( Figure 3). The avermectin family displayed extraordinarily potent anthelmintic properties. The first publications on avermectin appeared in 1979, describing it as a complex mixture of 16-membered macrocyclic lactones produced by fermentation of the actinomycete Streptomyces avermitilis-later re-classified as S. When the avermectins were discovered, they represented a completely new class of compounds, 'endectocides', so designated because they killed a diverse range of disease-causing organisms-as well as pathogen vectors-inside as well as outside the body. Moreover, all the treatments have been made available free of charge thanks to the unprecedented drug donation program. Most of the recipients live in remote, rural, desperately under-resourced communities in developing countries and have virtually no access to even the most rudimentary of medical interventions. For most of this century, some 250 million people have been taking it annually to combat two of the world’s most devastating, disfiguring, debilitating and stigma-inducing diseases, Onchocerciasis and Lymphatic filariasis. Perhaps more than any other drug, ivermectin is a drug for the world’s poor. ![]() However, health workers are increasingly utilizing it in an unsanctioned manner to treat a diverse range of other diseases, as shown in Appendix 1. It is approved for human use in several countries, ostensibly to treat Onchocerciasis, lymphatic filariasis (also known as Elephantiasis), strongyloidiasis and/or scabies and, very recently, to combat head lice. This unprecedented compound has mainly been used in humans as an oral medication for treating filarial diseases but is also effective against other worm-related infections and diseases, plus several parasite-induced epidermal parasitic skin diseases, as well as insect infestations. Ivermectin is a broad-spectrum anti-parasitic agent, primarily deployed to combat parasitic worms in veterinary and human medicine. ![]() Today, ivermectin remains a relatively unknown drug, although few, if any, other drugs can rival ivermectin for its beneficial impact on human health and welfare. Instead, it is the current status, beneficial global health impact and exciting future potential that ivermectin has to offer to human health worldwide that will be the focus of attention. ![]() ![]() Many excellent, eloquent and comprehensive reviews covering the discovery, advent, development, manufacture and distribution of ivermectin have been published by those intimately involved with the various stages.
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