Pediatric Amebiasis Medication

  • Author: Vinod K Dhawan, MD, FACP, FRCP(C), FIDSA; Chief Editor: Russell W Steele, MD   more...
 
Updated: May 10, 2012
 

Antibiotics

Class Summary

Activity against anaerobic bacteria and protozoa is exhibited by several agents. Metronidazole is considered the drug of choice for symptomatic, invasive disease. Paromomycin is the drug of choice for noninvasive disease. Because parasites persist in the intestine of 40-60% of patients treated with metronidazole, follow it with paromomycin to cure luminal infection. Do not give the 2 medications at the same time because the diarrhea that often results from paromomycin might be confused with continuing active intestinal disease from the parasite.

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Metronidazole (Flagyl, Protostat)

 

Kills trophozoites of E histolytica in intestine and tissue. Does not eradicate cysts from intestines.

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Tinidazole (Fasigyn, Tindamax)

 

5-nitroimidazole derivative with selective antimicrobial activity against anaerobic bacteria and protozoa. The mechanism by which tinidazole exhibits activity against Giardia and Entamoeba species is not known.

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Paromomycin (Humatin)

 

Amebicidal aminoglycoside antibiotic that is poorly absorbed. Active only against intraluminal form of amebiasis. Used to eradicate cysts of E histolytica following treatment with metronidazole or tinidazole for an invasive disease.

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Anthelmintics

Class Summary

Parasite biochemical pathways are different from the human host; thus, toxicity is directed to the parasite, egg, or larvae.

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Iodoquinol (Yodoxin)

 

Halogenated hydroxyquinoline. Luminal amebicide; acts primarily in bowel lumen because it is poorly absorbed. Best tolerated when given with meals. Because it is active only against intraluminal form of amebiasis, it is used to eradicate cysts of E histolytica after treatment of invasive disease.

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Chloroquine phosphate (Aralen)

 

Inhibits growth by concentrating within acid vesicles of parasite, which increases internal pH of organism. Also inhibits hemoglobin utilization and metabolism of parasite. In vitro studies with trophozoites of E histolytica demonstrate that chloroquine possesses amebicidal activity comparable to that of emetine. Highly effective in treatment of amebic liver abscess when administered with emetine or dehydroemetine. Like emetine and dehydroemetine, it is not effective against luminal forms. Irreversible retinal damage does not occur with dose and duration used for treatment of hepatic amebiasis.

Dehydroemetine (Mebadin)

 

Preferred over emetine because it is less toxic. Eradicates amebic tissue infections, including liver abscess, but does not act on luminal forms. Luminal amebicide also must be used to eradicate the bowel luminal infection. Only effective against the trophozoite forms and not the cyst form. Available in United States only from the Parasitic Disease Drug Service, CDC (Atlanta, GA 30333, [404-639-3670]). For more information, see CDC Drug Service.

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Diloxanide (Furamid, Entamizole, Furamide)

 

Luminal amebicide; acts primarily in bowel lumen because it is poorly absorbed. Used to eradicate cysts of E histolytica after treatment of invasive disease. Not available in the United States.

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Contributor Information and Disclosures
Author

Vinod K Dhawan, MD, FACP, FRCP(C), FIDSA  Professor, Department of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Infectious Diseases, Rancho Los Amigos National Rehabilitation Center

Vinod K Dhawan, MD, FACP, FRCP(C), FIDSA is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Royal College of Physicians and Surgeons of Canada

Disclosure: Pfizer Inc Honoraria Speaking and teaching

Coauthor(s)

Thomas R Naparst, MD  Clinical Instructor in Emergency Medicine, New York University School of Medicine; Consulting Staff, Department of Emergency Medicine, New York Downtown Hospital

Thomas R Naparst, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael D Nissen, MBBS, FRACP, FRCPA  Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital

Michael D Nissen, MBBS, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Maria A Horga, MD, to the development and writing of this article.

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Entamoeba histolytica trophozoite. Courtesy of Centers for Disease Control and Prevention.
Entamoeba histolytica cyst. Courtesy of Centers for Disease Control and Prevention.
Life cycle of Entameba histolytica.
Gross pathology of intestinal ulcers due to amebiasis. Courtesy of Centers for Disease Control and Prevention.
Histopathology of typical flask-shaped ulcer of intestinal amebiasis. Courtesy of Centers for Disease Control and Prevention.
Entamoeba histolytica in liver aspirate, trichrome stain. Courtesy of Centers for Disease Control and Prevention.
Histopathology of amebiasis. Courtesy of Centers for Disease Control and Prevention.
 
 
 
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