Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to page options Skip directly to site content

Investigational Drug Available Directly from CDC for the Treatment of Free-Living Ameba Infections

Health Alert Network logo.

This is an official

CDC HAN INFOService

Distributed via the CDC Health Alert Network
August 23, 2013, 11:30 ET (11:30 AM ET)
HANINFO-00354

Summary

CDC now has an expanded access investigational new drug (IND) protocol in effect with the Food and Drug Administration (FDA) to make miltefosine available directly from CDC to clinicians for treatment of free-living ameba (FLA) infections in the United States.

Background

Infections caused by FLA are severe and life-threatening. These infections include primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri* and granulomatous amebic encephalitis caused by Balamuthia mandrillaris† and Acanthamoeba species.§ Although several drugs have in vitro activity against FLA, mortality from these infections remains greater than 90% despite treatment with combinations of drugs.

Miltefosine is a drug used to treat leishmaniasis and also has shown in vitro activity against FLA (1), but as an investigational drug, it has not been readily available in the United States. With CDC assistance, however, miltefosine has been administered in combination with other drugs since 2009 for FLA infections as single-patient emergency use with permission from the Food and Drug Administration. Although the number of B. mandrillaris and Acanthamoeba species infections treated with a miltefosine-containing regimen is small, it appears that a miltefosine-containing treatment regimen does offer a survival advantage for these usually fatal infections (2). Miltefosine has not been used successfully to treat a Naegleria infection, but the length of time it has taken to import miltefosine from abroad has made timely treatment of fulminant Naegleria infections with miltefosine difficult.

CDC now has an expanded access IND protocol in effect with the Food and Drug Administration to make miltefosine available directly from CDC for treatment of FLA in the United States. The expanded access IND use of miltefosine for treatment of FLA is partly supported by 26 case reports of FLA infection from around the world during the period of 2008–2012 in which miltefosine was part of the treatment regimen (Unpublished data, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, 2013). Miltefosine is generally well-tolerated, with gastrointestinal symptoms as the most commonly reported adverse effects.

Recommendations

Clinicians who suspect they have a patient with FLA infection who could benefit from treatment with miltefosine should contact CDC to consult with an FLA expert. See the For More Information section below for information on contacting a CDC FLA expert.

For More Information

References

  1. Schuster FL, Guglielmo BJ, Visvesvara GS. In-vitro activity of miltefosine and voriconazole on clinical isolates of free-living amebas: Balamuthia mandrillaris, Acanthamoeba spp., and Naegleria fowleri. J Eukaryot Microbiol 2006;53:121–6.
  2. Cope JR, Roy SL, Yoder JS, Beach MJ. Improved treatment of granulomatous amebic encephalitis and other infections caused by Balamuthia mandrillaris and Acanthamoeba species [Poster]. Presented at CSTE Annual Conference, Pasadena, CA, June 9–13, 2013. Available at http://www.cste2.org/confpresentations/uploadedfiles/cste 2013 miltefosine Poster final.pdf.

Endnotes

* Additional information available at http://www.cdc.gov/parasites/naegleria.
† Additional information available at http://www.cdc.gov/parasites/balamuthia.
§ Additional information available at http://www.cdc.gov/parasites/acanthamoeba.

The Centers for Disease Control and Prevention (CDC) protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations.

Department of Health and Human Services

HAN Message Types

  • Health Alert: Conveys the highest level of importance; warrants immediate action or attention. Example: HAN00001
  • Health Advisory: Provides important information for a specific incident or situation; may not require immediate action. Example: HAN00346
  • Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action. Example: HAN00342
  • Info Service: Provides general information that is not necessarily considered to be of an emergent nature. Example: HAN00345

###
This message was distributed to state and local health officers, state and local epidemiologists, state and local laboratory directors, public information officers, HAN coordinators, and clinician organizations.
###

Ready: Prepare. Plan. Stay Informed.Social Media at CDC Emergency

TOP