Amebiasis Medication

  • Author: Alexandre Lacasse, MD, MSc; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 10, 2012
 

Medication Summary

  • Asymptomatic amebiasis should be treated with a luminal agent (iodoquinol, paromomycin, diloxanide furoate) to eradicate infection. This recommendation is based on two arguments: First, invasive disease may develop; second, shedding of E histolytica cysts in the environment is a public health concern.[1]
  • Asymptomatic E dispar infections should not be treated, but education should be pursued since it is a marker of fecal-oral contamination.[1]
  • Amebic colitis is first treated with a nitroimidazole derivative (metronidazole being the only one available in the United States), followed by a luminal agent to eradicate colonization.[1]
  • Amebic liver abscess can be cured without drainage and even by one dose of metronidazole. Clinical defervescence should occur during the first 3-4 days of treatment. Metronidazole failure may be an indication for surgical intervention. Treatment with a luminal agent should also follow.[1]
  • Disseminated amebiasis should be treated with metronidazole, which can cross the brain-blood barrier.
  • Empirical antibacterial agents should be used concomitantly if perforated viscus is a concern.
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Amebicides

Class Summary

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.

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Iodoquinol (Yodoxin)

 

Amebicidal against E histolytica. Considered effective against trophozoite and cyst forms.

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Paromomycin (Humatin)

 

Amebicidal and antibacterial aminoglycoside obtained from a strain of Streptomyces rimosus, active in intestinal amebiasis against trophozoite and cyst forms of E histolytica. Recommended for the treatment of Diphyllobothrium latum, Taenia saginata, Taenia solium, Dipylidium caninum, and Hymenolepis nana.

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Diloxanide (Entamide, Furamide)

 

Dichloroacetamide derivative. Amebicidal against trophozoite and cyst forms of E histolytica. Not available in United States.

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Metronidazole (Flagyl)

 

Active against various anaerobic bacteria and protozoa. Appears to be absorbed into cells. Intermediate metabolized compounds are formed and bind DNA and inhibit protein synthesis, causing cell death. Antimicrobial effect may be due to production of free radicals.

Indicated for invasive amebiasis.

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Tinidazole (Fasigyn)

 

5-Nitroimidazole derivative used for susceptible protozoal infections. Indicated to treat intestinal amebiasis and amebic liver abscess caused by E histolytica in adults and children aged 3 y and older.

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Contributor Information and Disclosures
Author

Alexandre Lacasse, MD, MSc  Internal Medicine Faculty, Assistant Director, Medicine Clinic, Infectious Disease Consultant, St Mary's Health Center

Alexandre Lacasse, MD, MSc is a member of the following medical societies: American College of Physicians, American Medical Association, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Coauthor(s)

Kerry O Cleveland, MD  Associate Professor of Medicine, University of Tennessee College of Medicine; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis

Kerry O Cleveland, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

J Robert Cantey, MD  Professor, Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina

J Robert Cantey, MD is a member of the following medical societies: Alpha Omega Alpha, American Society for Clinical Investigation, American Society for Microbiology, Infectious Diseases Society of America, International Society of Travel Medicine, Musculoskeletal Infection Society, Phi Beta Kappa, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Specialty Editor Board

Klaus-Dieter Lessnau, MD, FCCP  Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael Stuart Bronze, MD  Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Robert Swords, MD, to the development and writing of this article.

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Trichrome stain of Entamoeba histolytica trophozoites in amebiasis. Two diagnostic characteristics are observed. Two trophozoites have ingested erythrocytes, and all 3 have nuclei with small, centrally located karyosomes.
Trichrome stain of an Entamoeba histolytica cyst in amebiasis. Each cyst has 4 nuclei with characteristically centrally located karyosomes. Cysts measure 12-15 mm.
 
 
 
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