Pediatric Amebiasis Treatment & Management

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

Medical Care

Asymptomatic infections are not treated in endemic areas. However, in nonendemic areas, asymptomatic infection should be treated because of its potential to progress to invasive disease.[40] Luminal agents that are minimally absorbed by the GI tract (eg, paromomycin, iodoquinol, diloxanide furoate) are best suited for such therapy.[41, 42]

Metronidazole is the mainstay of therapy for invasive amebiasis.[40, 43, 44] Tinidazole has been recently approved by the US Food and Drug Administration (FDA) for intestinal or extraintestinal amebiasis. Other nitroimidazoles with longer half-lives (ie, secnidazole, ornidazole) are currently unavailable in the United States. Nitroimidazole therapy leads to clinical response in approximately 90% of patients with mild-to-moderate amebic colitis. Chloroquine has also been used for patients with hepatic amebiasis. Dehydroemetine (available from the Centers for Disease Control and Prevention [CDC] Drug Services [404-639-3670]) has been successfully used but is not preferred due to its potential myocardial toxicity. For more information, see CDC Drug Service.

Intraluminal parasites are not affected by nitroimidazole therapy. Therefore, nitroimidazole therapy should be followed by treatment with a luminal agent such as paromomycin or diloxanide furoate to prevent a relapse. The recommended dose and the duration of therapy are described under the individual agents discussed in Medication.

Broad-spectrum antibiotics may be added to treat bacterial superinfection in a case of fulminant amebic colitis and suspected perforation. Bacterial coinfection of amebic liver abscess has occasionally been observed (both before and as a complication of drainage), and adding antibiotics to the treatment regimen is reasonable in the absence of a prompt response to nitroimidazole therapy.

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Surgical Care

Surgical intervention is required for acute abdomen due to perforated amebic colitis, massive GI bleeding, or toxic megacolon.[45] Toxic megacolon is rare and is typically associated with the use of corticosteroids. Surgical attempts to correct amebic bowel perforation or peritonitis should be avoided, although some patients may benefit from peritoneal lavage.

Unlike pyogenic liver abscess, amebic liver abscess generally responds to medical therapy alone and drainage is seldom necessary. When necessary, imaging-guided percutaneous treatment (needle aspiration or catheter drainage) has replaced surgical intervention as the procedure of choice for reducing the size of an abscess. The indications for drainage of amebic liver abscess include the following:

  • Presence of left-lobe abscess (>10 cm in diameter)
  • Impending rupture and abscess that does not respond to medical therapy within 3-5 days
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Consultations

  • Infectious disease specialist
  • Gastroenterologist
  • Surgeon
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Diet

No special diet is recommended.

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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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