Intestinal amoebiasis, treatment

Asymptomatic carriers

Since high percentages of the population may be cyst carriers (e.g. 10%) there is little point in treating cyst carriers found by chance in an endemic region. In any case, 90-95% of these people are infected with the non-pathogenic Entamoeba dispar. If this is nevertheless desired (e.g. in people who prepare food) diloxanide furoate (Furamide®) is indicated. Iodoquinol (Intetrix®) and paromomycin (Gabbroral®, Humatin®) can be used. In regions of low endemicity it may indeed be sensible to treat the patient to prevent transmission, and also to prevent possible development of later invasive amoebiasis.

Amoebic colitis

Parasites in the tissues (intestinal wall) can be treated with metronidazole or tinidazole. The dose of metronidazole (Flagyl®) is 500 mg q.i.d. for 5 or more consecutive days (adults). Tinidazole (Fasigyn®) is more expensive but has fewer side effects. Alcohol is forbidden during treatment due to antabuse effect with severe nausea. These drugs are rapidly absorbed in the proximal intestine. For this reason they are insufficiently active upon the parasites in the distal intestinal lumen.

The latter are treated with diloxanide furoate (Furamide® = a contact amoebicide). This drug is not active, however, against parasites in the tissues. The two drugs thus complement each other. Dose: Furamide® 500 mg t.i.d. for 10 days (adults). Children: 30 mg/kg/day. Alternative contact amoebicides are iodoquinol and paromomycine (Gabbroral®, Humatin®) which have a somewhat higher relapse percentage, although this is not certain.

Category: Medicine Notes