infectious diseases
Amebiasis
Treatment of Amebiasis
Initially,metronidazole,tinidazole, or sometimesnitazoxanide Iodoquinol,paromomycin, or diloxanide furoate subsequently for cyst eradication Forgastrointestinal symptoms and extraintestinal amebiasis,one of the following is used: Oralmetronidazole500 to 750 mg 3 times a day in adults (12 to 17 mg/kg 3 times a day in children) for 7 to 10 days Tinidazole2 g orally once/day in adults (50 mg/kg [maximum 2 g] orally once/day in children > 3 years) for 3 days for mild to moderate gastrointestinal symptoms, 5 days for severe gastrointestinal symptoms, and 3 to 5 days for amebic liver abscess Metronidazoleandtinidazoleshould not be given to pregnant women. Alcohol must be avoided because these drugs have adisulfiram-like effect. In terms of gastrointestinal adverse effects,tinidazoleis generally better tolerated thanmetronidazole. is an effective alternative for noninvasive intestinal amebiasis (500 mg orally 2 times a day for 3 days taken with food), but efficacy against invasive disease is not known; therefore, it should only be used if other treatments are contraindicated ( Treatment references , Therapy for patients with significant gastrointestinal symptoms should include rehydration with fluid and electrolytes and other supportive measures. Althoughmetronidazole,tinidazole, andnitazoxanidehave some activity againstE. histolyticacysts, they are not sufficient to eradicate cysts. Consequently, a 2nd oral drug is used to eradicate residual cysts in the intestine. Options for cyst eradication are Iodoquinol650 mg orally 3 times a day after meals in adults (10 to 13 mg/kg [maximum of 2 g/day] orally 3 times a day in children) for 20 days Paromomycin8 to 11 mg/kg orally 3 times a day with meals for 7 days Diloxanide furoate 500 mg orally 3 times a day in adults (7 mg/kg orally 3 times a day in children) for 10 days Diloxanide furoate is not available commercially in the US but may be obtained through some compounding pharmacies. The pathogenicity ofE. moshkovskiiandE. bangladeshiis uncertain. They have been identified in stools primarily in children with and without diarrhea in impoverished areas where fecal contamination of food and water is present. Molecular diagnostic tests to identify them are available only in research settings. The optimal treatment is unknown, but they are likely to respond to drugs used forE. histolytica. Asymptomatic peoplewho passE. histolyticacysts should be treated withparomomycin,iodoquinol, or diloxanide furoate (see above for doses) to prevent development of invasive disease and spreading elsewhere in the body and to others. Treatment is not necessary forE. disparor asymptomaticE. moshkovskiiandE. bangladeshiinfections until more is known about their pathogenicity. 1.Rossignol JF, Kabil SM, El-Gohary Y, et al:Nitazoxanidein the treatment of amoebiasis.Trans R Soc Trop Med Hyg101(10):1025-31, 2007. doi: 10.1016/j.trstmh.2007.04.001 2.Escobedo AA, Almirall P, Alfonso M, et al: Treatment of intestinal protozoan infections in children.Arch Dis Child94(6):478-82, 2009. doi: 10.1136/adc.2008.151852 