What is the recommended dose of Diloxanide (Diloxanide furoate) for treating amoebiasis?

Diloxanide Furoate Dosage for Amoebiasis Treatment

The recommended dose of diloxanide furoate for treating amoebiasis is 500 mg orally three times daily for 10 days. 1

Indications and Usage

Diloxanide furoate is primarily indicated as a luminal amoebicide for:

• Asymptomatic cyst passers
• Follow-up therapy after treatment with metronidazole or tinidazole for invasive amoebiasis

Treatment Algorithm

1. For invasive amoebiasis (amoebic liver abscess):

   • Initial treatment with metronidazole 500 mg three times daily for 7-10 days or tinidazole 2 g daily for 3 days 1
   • Follow with diloxanide furoate 500 mg three times daily for 10 days to eliminate intestinal cysts and prevent relapse 1

2. For asymptomatic intestinal amoebiasis:

   • Diloxanide furoate 500 mg three times daily for 10 days as monotherapy 2

Efficacy

Diloxanide furoate has demonstrated excellent efficacy as a luminal agent:

• Parasitological cure rates of 88-93% in asymptomatic carriers 2
• Superior to metronidazole/tinidazole (which showed only 29-56% cure rates) for eliminating intestinal cysts 2
• 100% parasitic clearance when combined with metronidazole in a combined formulation 3

Mechanism of Action

While the exact mechanism remains not fully understood, diloxanide furoate likely:

• Acts against protein synthesis in E. histolytica trophozoites
• Blocks conversion to more virulent and invasive cyst forms
• Has structural similarity to chloramphenicol at the dichloroacetamide group 4

Special Populations

Children

• The same adult dosage (500 mg three times daily) has been used in combination therapy for children with amoebic dysentery 5
• However, specific pediatric dosing guidelines are limited in the literature

Pregnant Women

• Safety during pregnancy has not been well established
• Should be used only when clearly needed and when potential benefits outweigh risks

Adverse Effects

Common side effects include:

• Flatulence (most common)
• Anorexia
• Headache
• Urticaria 4

Clinical Pearls

1. Diloxanide furoate is administered in ester form, which allows high luminal concentration and greater efficacy than metronidazole for asymptomatic intestinal amoebiasis 4

2. For invasive amoebiasis (including amoebic liver abscess), always follow metronidazole or tinidazole treatment with diloxanide furoate to eliminate intestinal cysts and prevent relapse 6

3. Diloxanide furoate is particularly effective for asymptomatic carriers, with significantly higher cure rates compared to nitroimidazoles alone 2

4. The standard 10-day course is essential for complete elimination of intestinal cysts