Amebic dysentery

Amebic Dysentery – Treatment Overview

Introduction
Amebic dysentery is the invasive intestinal form of amebiasis caused by Entamoeba histolytica. It is characterized by bloody diarrhea, abdominal cramps, fever, and weight loss due to invasion of the colonic mucosa. If untreated, it may lead to complications such as toxic megacolon, perforation, or peritonitis. Treatment requires rapid eradication of both invasive trophozoites and intraluminal cysts to prevent relapse and transmission.

---

Treatment Options and Doses

1. Tissue-Active Agents (for invasive disease)

• Metronidazole (first-line):

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

  • Children: 35–50 mg/kg/day orally in 3 divided doses (max 2.25 g/day) for 7–10 days.

• Tinidazole (alternative):

  • Adults: 2 g orally once daily for 3–5 days.

  • Children: 50 mg/kg/day orally once daily (max 2 g/day) for 3–5 days.

---

2. Luminal Agents (to eradicate cysts and prevent relapse)
After completing metronidazole or tinidazole, a luminal amebicide must be given:

• 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 (if available).

---

3. Supportive Therapy

• Fluid and electrolyte replacement: To correct dehydration from diarrhea.

• Nutritional support: Soft diet, avoid irritant foods.

• Avoid corticosteroids: They worsen invasive amebiasis and may precipitate perforation.

---

4. Severe or Complicated Amebic Dysentery

• IV metronidazole: 500 mg every 8 hours if oral route not possible.

• Hospitalization: For severe dehydration, shock, or suspected complications.

• Surgical intervention: Only if perforation or peritonitis develops.