Amebiasis

Amebiasis – Treatment Overview

Introduction
Amebiasis is an infection caused by the protozoan parasite Entamoeba histolytica, which spreads via the fecal–oral route, typically through contaminated food or water. It can present as:

• Intestinal disease: Asymptomatic colonization, mild diarrhea, or invasive dysentery.

• Extraintestinal disease: Most commonly liver abscess, but also pulmonary, cardiac, or cerebral spread in severe cases.

Treatment depends on whether the infection is asymptomatic (luminal infection), intestinal invasive, or extraintestinal (liver abscess, systemic disease).

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Treatment Options and Doses

1. Asymptomatic (Luminal Amebiasis)

• Paromomycin: 25–35 mg/kg/day orally in 3 divided doses for 7 days.

• Iodoquinol: 650 mg orally three times daily for 20 days.

• Diloxanide furoate: 500 mg orally three times daily for 10 days (not widely available).

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2. Intestinal Amebiasis (Symptomatic Dysentery)

• Metronidazole: 750 mg orally three times daily for 7–10 days.

  • Children: 35–50 mg/kg/day in 3 divided doses for 7–10 days.

• Followed by a luminal agent (paromomycin, iodoquinol, or diloxanide) to eradicate intraluminal cysts and prevent relapse.

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3. Amebic Liver Abscess

• Metronidazole: 750 mg orally or IV three times daily for 7–10 days.

• Alternative: Tinidazole 2 g orally once daily for 5 days.

• Always followed by a luminal agent (e.g., paromomycin 25–35 mg/kg/day for 7 days).

• Drainage: Rarely required unless abscess is very large, at risk of rupture, or not responding to therapy.

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4. Severe / Complicated Disease

• IV metronidazole if oral administration is not possible.

• Supportive measures: IV fluids, electrolyte correction, and broad-spectrum antibiotics if secondary bacterial infection suspected.

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5. Supportive Measures

• Adequate hydration and nutrition.

• Avoidance of corticosteroids (they worsen invasive disease).

• Monitoring for complications (e.g., perforation, massive colitis).