Treatment of amoebiasis

Seek expert advice.

• metronidazole is the drug of choice (1):
  • in amoebic colitis 800 mg three times daily for five days is given (adult)
  • if there is liver involvement or other extra-intestinal spread then the course of treatment is for 10-14 days
  • treatment with metronidazole is followed by a 10-day course of diloxanide furoate
• for asymptomatic (chronic) disease when Entamoeba cysts, not vegetative forms, are present in the stool, then use diloxinide furoate.
• a large amoebic liver abscess may require percutaneous drainage (1)
  • metronidazole (400 mg three times daily) is given for 10 days repeated after 2 weeks as required.
• prevention is by sanitary disposal of faeces, filtration or boiling of water. Cysts are resistant to usual levels of chlorination.

A review concerning management of acute infectious diarrhoea also suggests the regime for amoebic dysentery as metronidazole plus diloxanide furoate. Paromomycin is suggested as an alternative to diloxanide furoate (2).

The respective summary of product characteristics must be consulted before prescribing any of the drugs mentioned.

Notes:

• tinidazole is an alternative to metronidazole
• the treatment of amoebic liver abscess with metronidazole alone or in combination with ultrasound-guided needle aspiration has been investigated in a comparative, prospective and randomized study
  • the study authors concluded that the minor benefit associated with aspiration of the abscess was not sufficient to justify routine needle aspiration and advocates drug treatment alone for uncomplicated amoebic liver abscesses with a diameter up to 10 cm located in the right liver lobe (3)

Reference:

1. BNF 5.4.2
2. McMahan ZH, Dupont HL. Review article: the history of acute infectious diarrhoea management - from poorly focused empiricism to fluid therapy and modern pharmacotherapy. Aliment Pharmacol Ther. 2007 Apr 1;25(7):759-69.
3. Blessman J et al. Treatment of amoebic liver abscess with metronidazole alone or in combination with ultrasound-guided needle aspiration: a comparative, prospective and randomized study. Trop Med Int Health. 2003 Nov;8(11):1030-4.