Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

108 Amebiasis

Treatment Options

■Intestinal disease:

➣asymptomatic (eliminate intraluminal cysts): paromomycin for

7 days or: Iodoquinol for 20 days or: diloxanide furoate for 10

days (obtainable only from the CDC)

➣mildly to moderately symptomatic disease: metronidazole for

7–10 days or tinadazole 3 days followed by one of the intestinal

regimens above

➣severe dysentery or systemic disease: metronidazole for 10 days

or tinadazole 3–5 days followed by one of the intestinal regimens.

Large abscesses may require aspiration or surgical drainage, as

does pericardial disease.

Side Effects & Complications

■Iodoquinol: occasional mild GI distress. Only about 1% is absorbed.

Possible myelo-optic neuropathy in excessive doses. Avoid in those

with iodine intolerance.

■Paromomycin: sometimes nausea, cramps, diarrhea. Only about 1%

absorbed.

■Diloxanide furoate: flatulence, mild GI distress. Poorly absorbed.

■Metronidazole: dizziness, nausea, malaise, metallic taste in mouth,

tingling in extremities, Antabuse-like reaction with alcohol

Tinadazole: GI distress, metallic taste, fatigue. Contraindicated in first

trimester of pregnancy (C).

■Contraindications to treatment: absolute: allergy to drug

■Contraindications to treatment: relative: first trimester of preg-

nancy. In severe disease metronidazole can be used. Paromomycin

is intestinal agent of choice, only after ulcerative disease controlled

by metronidazole.

follow-up

During Treatment

■Intestinal disease: in severe disease monitor fluids, watch for hem-

orrhage and perforation

■Systemic disease: hospital care until stable

Routine

■Intestinal: check stool O&P 4 weeks after end of chemotherapy.

Retreat if needed.

■Systemic disease: follow liver abscess with ultrasound. Retest stools

4 weeks after therapy if positive originally or if not done.